Ihilp1':; &*c;-"--;£■■«£' ill: lli:; I iiiiiiiiiiiiiiiiMI llIlllitP'lfi^!it':! mfrfofafawi'' ini'i^'*i''>\rffiWM:wvv&»'^'^fti>iy^ w ,-li^ ^st* ■An perfoliatum and purpureum, Artemisia vulgaris, Absinthium, Millefolium, Taraxacum, and Calendula. r Compositae. < Arnica. Chamomilla. Cina. Capillaries. Typhoid. Injuries. Organs. I Abdomen. Brain and spine. Fever. [ Organs. Artemisia vulgaris. ) -r, • ■, , „ ., . , . ° [ Bram and medulla. Absinthium. ) Fever. Millefolium. Eupatorium perf. Eupatorium purp. ^ Taraxacum.—Liver. We will now proceed to study the first one of these. Arnica Montana. Arnica montana is commonly called leopard's bane. The tincture of Arnica montana should be prepared from the roots of the plant rather than from the flowers, because the latter are infested by a little insect, the bodies of which, together with the eggs, considerably 222 A CLINICAL MATERIA MEDICA. modify the action of the pure drug, and, of course, add symptoms which are foreign to the genuine effects of Arnica. We also find an essential oil in the flowers differing somewhat from that found in the roots. I hardly know why the plant has been called the leopard's bane, for it is hardly poisonous. While there have been a few cases of death resulting from its extravagant use, most of them have been traced to preparations in which the flowers were used, so that it is not unlikely that the fatal result was due to the insects. The species which is officinal in our materia medica, the Arnica montana, does not grow in this country, but is indigenous to Europe. Its essential oil contains an imperfectly known alkaloid called Arnicin, and a starchy substance known as Inulin. To properly understand Arnica as a whole you must know that it affects the bloodvessels. Exactly how it does this, I can hardly tell you as it is not clearly defined in my own mind; but the results I can tell you. It so affects the bloodvessels, particularly the capillaries, that dilatation of the smaller bloodvessels and extravasation of blood becomes possible. This weakening of the capillary walls, which ad- mits of extravasation of blood, explains the application of Arnica to trauma. It also explains the application of the drug to typhoid conditions. Now keep before your minds, that Arnica so alters the capillaries that blood may ooze through their walls, and you will un- derstand its symptoms. There seems to be a venous stasis producing an extravasation of blood. This form of oozing cannot occur from a healthy vessel. Arnica is applicable to both the acute and chronic effects of injuries. The acute injuries for which it is useful are the following: Simple bruises in which there are well-marked ecchymoses; concussions of the brain or spine or both. We have no remedy which equals Arnica in these last-named cases. Even compression of the brain comes within the range of Arnica, whether this compression be the result of a dis- placed fragment of bone in cranial fracture, or the result of effusion of blood within the cranial cavity. Arnica cannot', of course, cure in the former of these cases; an operation is demanded in order to obtain permanent relief. You may use Arnica in injuries of the muscles from a strain or from a sudden wrench, as in case of heavy lifting, and in haemorrhages of mechanical origin. Fractures of the bones may call for the use of Arnica both externally aud internally to relieve the swelling and tumefaction of the limb, and alos to relieve the twitching of muscles, a reflex symptom of the fracture. ARNICA MONTANA. 223 In chronic effects of injury we may use Arnica when diseases which may even be entirely foreign in their appearance to the ordinary symptomatology of the drug may be traced to a traumatic origin. No matter what that disease may be, whether of the brain, eyes, lungs or nerves, if the injury is the exciting cause, the administration of Arnica is proper. Again, as Arnica undoubtedly acts on the muscular tissue itself, we may use it for the consequences of diseases in the muscle; for instance, when one has been working very laboriously, and in consequence the whole body feels sore and bruised as if pounded; or again, v/hen heavy work may have caused hypertrophy of the heart. This last-named is not strictly a disease, but it ends in disease. The heart is a muscle that grow7s under the stimulus of exercise as much as does the biceps of the arm. As a result of the cardiac hypertrophy, the patient com- plains of swelling of the hands on any exertion. The hand becomes redder than natural, and swells when the arm is permitted to hang down. The pulse you will find to be full and strong. When the heart has reached this stage of hypertrophy, there are local symptoms in ad- dition to those mentioned. The heart feels as though tightly grasped with the hand. The whole chest feels sore and bruised, and he cannot bear his clothing to touch it. This will at once suggest to you Cactus, which has that constriction about the heart. Cactus, however, does not have a traumatic origin for its symptoms. The sensitiveness of the chest suggests Lachesis, but it is a different symptom under Arnica which has not that sensitiveness of the per- ipheries of the nerves that Lachesis has; but it is a true soreness from fulness of the bloodvessels. Other remedies to be compared with Arnica in this hypertrophy of the heart are: Rhus tox., especially if there is a rheumatic diathesis. Arsenicum, if it has resulted from climbing high places. Bromine has also been successfully used in this condition. Now let me give you the typhoid symptoms of Arnica, which, although very different from those just mentioned, depend upon a similar condition of bloodvessels. The changes in the bloodvessels by the typhoid poison favor the formation of ecchymoses here and there over the body. There is also a passive congestion of the brain. This is shown by drowsiness and indifference to those about him and to his condition. The patient falls 224 A CLINICAL MATERIA MEDICA. asleep while answering questions, just as we find in Baptisia. With these symptoms you almost always find the head hot and the body not hot. I put it that way for brief. The symptom in the materia medica reads, " the head is hot and the body cool, or at least not hot," implying that there is a difference in temperature between the head and the rest of the body. That symptom has been so often confirmed that it is well for you to remember it. The patient complains of a bruised feeling all over the body, so that the bed feels too hard to him. He is restless and tosses about the bed to find a soft spot on which to rest; and yet the fault is not with the bed, it is with himself. Sugil- lations from hypostasis appear on the back. The lungs become affected—and here, too, the same character of Arnica shows itself. There is a cough, with expectoration of mucus and blood. If the patient is still sufficiently conscious he will complain of sore bruised feeling in the walls of the chest. As the case progresses still further, Arnica may yet be called for, when the pressure of the blood in the brain is sufficient to cause apoplectic symptoms. The breathing be- comes heavy, and even stertorous. The lower jaw drops. Petechae appear on the skin, and both stool and urine are passed involuntarily, the patient, of course, being in a stupor. These are the typhoid symp- toms of Arnica. Now for the muscular symptoms. Arnica develops a true myalgia. The pains occur in the muscles of any part of the body. They are of traumatic origin, or they come from over-exertion, and are accom- panied by this sore, bruised feeling, which is so necessary to the choice of the drug. In rheumatism, you may employ Arnica, not for true inflammatory rheumatism, but for the local rheumatism which occurs in winter weather, and which seems to be the combined effect often of exposure to dampness and cold and strain on the muscles from over-exertion. The affected parts feel sore and bruised. Any motion, of course, aggravates this sensation. There are sharp, shooting pains, which run down from the elbow to the forearm, or which shoot through the legs and feet. The feet often swell and feel sore and bruised. In cases of injuries, the drugs to be thought of in connection with Arnica are these: First, Rhus tox., which, as I have already told you more than once, is preferable to Arnica when the ligaments of a joint, rather than the soft parts, are involved in an injury. It acts on the fibrous structures. Arnica is suited more to tumefaction of the other tissues. ARNICA MONTANA. 225 Calendula is to be thought of when the injury causes a torn or ragged wound, possibly with loss of substance. Calendula removes the inflammatory condition of the part, and so permits of healthy granulation. Hypericum is to be substituted for Arnica when the nerves have been injured along with the other soft parts. Nothing equals Hypericum in case of mashed finger. It relieves the pain and promotes healing. It often follows Arnica in concussion of the spine. Dr. Ludlam, of Chi- cago, is very partial to Hypericum in this trouble of the spinal cord. He has relieved some severe cases with it. Another drug yet is Staphisagria. This is the remedy for smooth clean cuts, such as are made by the surgeon's knife, and hence it is called for in symptoms which are traceable to surgical operations. Even if the symptoms which follow are not apparently connected with the symptomatology of Staphisagria, you may expect, when they arise from this cause, to obtain relief by its administration. Ledum is useful after Arnica when the latter remedy fails to relieve the soreness. It is also suited to injuries inflicted by pointed instru- ments, therefore in punctured wounds. Symphytum officinale is the proper remedy for bone injuries. For example, when a blow on the eyes injures the orbital plates of the frontal bone. It may also be administered in case of irritable stump after amputation; and also for irritability of bone at point of fracture. If the latter condition is the result of impaired nutrition, Calcarea phos should be prescribed. Arnica may be used as a preventive of pyaemia. It is thought by some physicians that this remedy promotes the evacuation of pus, that it promotes the appearance of pus on the surface of a sore. With the object of preventing pyaemia, some surgeons use Arnica after opera- tions, applying it locally and giving it internally at the same time. This property of Arnica to prevent pyaemia lies at the foundation of the stereotyped practice among physicians of giving this drug to women after delivery. It tends to relieve the soreness following par- turition and promotes proper contraction of the uterus and expulsion of coagula and of any portions of the membranes that may have been retained. Arnica has an action on the skin, producing crops of boils all over the body. They begin with soreness and go on to suppuration, and are followed by another crop. It may also be used in boils and abscesses which have partially matured but which, instead of dis- 15 226 A CLINICAL MATERIA MEDICA. charging, shrivel up by reason of absorption of the contained pus. Arnica given internally and applied externally redevelops the abscess. Further, in connection with the action of Arnica, I would call your attention to the effects of the drug on the gastro-intestinal tract. We find it indicated in dyspepsia, when, after a meal, there is impending apoplectic congestion of the brain with throbbing headache and drowsiness; and also, when there is some difficulty in the digestion of food; there are foul breath, slimy yellow coating of the tongue, eructa- tion of gas tasting like rotten eggs, tympanitic distension of the ab- domen and foul-smelling stools. Arnica may be called for in cholera infantum, diarrhoea, or dysen- tery; the stools have a foul ordor and are slimy, bloody, and even purulent, and are accompanied by great urging and straining to stool. The dyspeptic symptoms just mentioned will be present, and there are sharp, stitching pains through the abdominal walls. The patient is thirsty, and yet he does not know what he wants to drink. I should like, in closing my remarks on Arnica, to mention its use in whooping-cough. It is indicated in children who have a violent tickling cough, which seems to be excited whenever the child becomes angry. The child loses its breath when it cries. Before a paroxysm it begins to cry. Why? The lungs and trachea are sore. The little sufferer knows what is coming and dreads it; that is the interpreta- tion of the symptom. The expectoration is frothy, slimy, and always mixed with blood. In compression of the brain from apoplectic extravasation of blood, Arnica may be used when associated with the hemiplegia; there is an aching soreness all over the body. Bed-sores form very readily. Artemisia Vulgaris. Artemisia vulgaris, another member of the order Compositae, is a very serviceable remedy in epilepsy, when the attacks have been brought on by violent emotions, and especially by fright; when the attacks come in closely repeated-seizures, that is to say, when there are several convulsions coming close together, and then a long interval of rest. The paroxysms are usually followed by sleep. Again, Artemisia vulgaris seems to be of some use in that form of epilepsy known as "petit mal." The patient is walking in the street, when, suddenly, he stops, stares into vacancy, mumbles a few words possibly, regains a normal condition, and then goes his way totally unconscious of anything unusual having elapsed. ABSINTHIUM, MILLEFOLIUM, TARAXACUM. 227 Artemisia has, like other members of the order {Cina more promi- nently than any of the others), an effect on the eye. We find under the drug this symptom: "Colored light produces dizziness;" for ex- ample, when seated near a stained-glass window the patient becomes dizzy. In addition to this it causes a well-developed asthenopia of this kind: On attempting to use the eyes the patient experiences pain in them, together with blurring of the vision, the latter symptom being momentarily relieved by rubbing the eyes. This is easily explained; the asthenopia is due to muscular defect and error of accommodation. By rubbing the eyes, the accommodation is temporarily restored. Absinthium. Absinthium, another form of wormwood, is of interest to you not only as a medicine, but also because you will meet with cases of its abuse in those who indulge in it as a drink. The first effect of Absinthe is an exhilaration of the mind soon followed by damaging results, among which is horrible delirium. In this delirium the patient is obliged to walk about. You will note this symptom running through all the remedies of the order. Chamomilla and Cina have relief from moving about; and Artemisia has desire to move about; and here under Absinthium the patient walks about in distress, seeing all sorts of visions. The use we may make of Absinthium is in the sleeplessness of typhoid fever when there is congestion at the base of the brain. Millefolium is of interest to you as being a remedy in haemorrhages from the lungs or bowels, of mechanical origin. The flow of blood is usually bright red. It is distinguished from Aconite by the absence of anxiety. Taraxacum, or the ordinary dandelion, is a decided liver remedy. If given long enough, it will produce a free flow of bile. The symptoms to guide you in its selection are these: The tongue is mapped, and there are bitter taste in the mouth, chilliness after eating or drinking, pain and soreness in the region of the liver and bilious diarrhoea. The use of this drug in typhoid fever was mentioned in a recent lecture. 228 A CLINICAL MATERIA MEDICA. Eupatorium Perfoliatum, or the bone-set, is a popular remedy in malarial districts for chills and fever. In this disease it is indicated by the following symptoms: The chill begins from seven to nine a. m., preceded by backache and insatiable thirst, which rarely continues into the fever. It first appears in the back and is accompanied by aching in the limbs, as though every bone in the body were being broken. This is followed by high fever with increase of the aching, and this by sweat, which is scanty or profuse. In some cases there is a double periodicity; the chill comes in the morning of one day and in the evening of the next. Eupatorium purpureum has been used for chill beginning in the back. I do not know of any symptom distinguishing it from Eupa- torium perfoliatum. You may also think of Eupatorium perfoliatum in influenza with hoarseness worse in the morning, and cough with extreme soreness along the trachea and even to the finest ramifications of the bronchial tubes. With this there will be the ordinary symp- toms, aching all through the body, etc. Artemisia Abrotanum. Artemisia abrotanum is suited to suddenly appearing cases of spinal inflammation and to chronic myelitis. There are sudden aching pains in the back which are relieved by motion, and numbness and paralysis. It is especially called for in rheumatic patients. LECTURE XXII. CINA AND CHAMOMILLA. Cina. The medicinal virtues of Cina are largely, although not entirely, due to a poisonous active principle which it contains; that active principle is Santonine, the central point of action of which is on the abdominal ganglia, whence are reflected nervous impressions to all other parts of the body, but principally to the brain and spine. As a result of this primary action on the abdominal ganglia, we have as reflex symptoms, convulsive twitchings and jerkings of the limbs and even violent spasms, these latter usually being of a tonic character. Strabismus also is present. Under the influence of Cina, the face is pale, and by the way, it continues so, even if there be fever. Ipecacuanha and Bryonia also have this symptom partially. With the pale face of Cina, there are usually7 associated dark rings about the eyes. The pupils are dilated. The child grinds its teeth during sleep. It also picks or bores at the nose with the finger. The sleep is restless and attended by crying out. This is the general action of Cina. You now know what you may expect of the drug. Taking these symptoms into account, we are led to the use of Cina for the presence of worms in the alimentary tract. The most careful analysis of clinical experience has demonstrated that Cina is most powerful for the elimination of round worms. The sickly appearance of the face, the blue rings about the eyes, and the grinding of the teeth associated with canine hunger, give a perfect picture for the drug. Cina so far corrects the abdominal organs and so far tones up the abdominal ganglia, that the mucous membrane of the alimentary tract pours forth a normal secretion, so that the worms no longer having a proper pabulum on which to subsist, die and are expelled. This, then, is the use of Cina. With the oxyures, those little worms which appear about the anus and get into the rectum, Cina is of no avail, because the symptoms caused by them are not symptoms of Cina. For these, we have another group of remedies. Aconite when the child is feverish and cannot sleep. When the child is simply much excited, you may give Ignatia. 230 A CLINICAL MATERIA MEDICA. Indigo is the best remedy when convulsions result from the worms. If all these fail, think of Quassia. Caladium seguinum is the best remedy when the worms, in little girls travel over the perineum and get into the vagina. The irritation they produce, may thus excite masturbation. We may also make use of Cina in affections of the eyes, especially in asthenopia from defective accommodation. When the patient at- tempts to read, his eyes begin to ache', the letters become blurred and a cloud comes over the eye-sight. Relief is obtained by rubbing the eyes. The same condition I have already told you, is found under Artemisia vulgaris. A very peculiar effect on the eye produced by Santonine is, that objects look y7ellow. Cina being a spasmodic remedy, we expect it to be useful in whoop- ing-cough, in which disease, it is indicated when the paroxysms come regularly through night or day and are accompanied by tonic convul- sions. Just after a paroxysm, a gurgling sound is heard. Cina may also be used in cough reflex from the irritation of worms. As a concomitant of all these conditions, we find the temperament of Cina. It is indicated in children who are irritable, nervous and peevish. They are obstinate and permit no one to approach them. Cina seems to have some effect on the bladder, producing wetting of the bed at night. The urine is white and turbid and sometimes has a very strong odor. Cina is not often used in intermittent fever, but it is sometimes in- dicated by thirst during the chill and occasionally during the fever also. Pale face is present even during the hot stage. There are also vomit- ing, canine hunger, and clean tongue. Like many of the other members of the order Compositae, the Cina patient finds relief from moving about. Chamomilla Matricaria. The Chamomilla of the homoeopathic materia medica is the German variety, the Chamomilla matricaria. The drug acts best apparently upon patients with a morbidly sensitive nervous system. It is like Coffea, Ignatia and Belladonna then, in so far as it lessens nervous ex- citability. Slight impressions produce distress and anguish of mind; pains often result in fainting. Here it is similar to Valerian, Hepar and Veratrum album. It is especially applicable to these symptoms when they appear after long-continued use of narcotics. chamomilla. 231 In every disease in which Chamomilla is indicated, we notice this peculiar excitability. The patient, whether it be child or adult, a woman in labor or with toothache, is cross and excitable. Unless this mental state is present, Chamomilla will most likely fail you. When violent emotions, as anger, affect the viscera, as, for example, the liver with jaundice, you may think of the drug under consideration. In this condition it stands related to a few drugs. Staphisagria is indicated in children when colic follows a fit of anger. Bryonia has gastro-enteric symptoms after anger. Under this remedy, however, the symptoms are associated with chilliness, under Chamomilla with heat; under Bryonia the face is dark red, under Chamomilla, pale with one red cheek. The Bryonia tongue is coated white, that of Chamomilla yellow. Continuing the nervous symptoms of Chamomilla, we find the drug useful for insomnia of children, when they start during sleep and the muscles of the face and hands twitch. With these symptoms there is apt to be colic; the face is red, especially one cheek, and the head and scalp are bathed in a hot sweat. A word of explanation is here neces- sary: Sometimes, during an attack of fever in a child, the cheek on which it lies becomes red; now that is not a Chamomilla symptom. These nervous symptoms of Chamomilla are generally reflex from the abdomen. There is very little evidence of delirium in these cases. When brain complications are present Chamomilla ceases to be the remedy, and Belladonna comes in. When, during dentition, Chamomilla fails, Belladonna is the remedy, because it is suited to a farther advanced state. This same nervous state of Chamomilla may be applied to the use of the drug in rheumatism. Rheumatic pains drive the patient out of bed and compel him to walk about. He is thirsty, hot, with red cheeks and almost beside himself with anguish. Stitching pains jump from place to place, but unlike Pulsatilla, they leave a sense of weakness and numbness. Sweat does not relieve him, but his pains are better after sweat. The analogous remedies here are Rhus, which lacks the excitement of Chamomilla; Ferrum metallicum, which has rheumatism better from moving about slowly; Veratrum album, which has maddening pains, compelling the patient to walk about. With the latter remedy there is not the feverishness and excitement which characterize Cham- omilla. Chamomilla also acts on mucous membranes, causing symptoms of catarrh, It is indicated in the catarrhs of children, when the nose is 232 A CLINICAL MATERIA MEDICA. " stopped up," and yet there is a dropping of hot, watery mucus from the nostrils; there are sneezing and inability to sleep, and with these a dry, teasing cough, which keeps the child awake, or may even occur during sleep; or there is rattling cough, as though the bronchi were full of mucus. Especially is Chamomilla useful in colds brought on by cold windy days. Nux vomica is also indicated in catarrhs, when there is a " stopped- up " feeling in the nose, but there is no secretion whatever. Sambucus is indicated in catarrh, when the child starts up suddenly as if suffocating. Sticta suits a hard, dry, barking cough; the nose is "stuffed up" and dry; the real condition is this, the nasal secretion dries so rapidly that it cannot be discharged. Chamomilla has a number of gastric symptoms. It is useful in biliousness produced by anger. We find it also indicated in gastral- gia, especially when the food eaten seems to lie like a load in the stomach. There is distension of the hypochondria, the tongue is coated yellowish-white, and there is a bitter taste in the mouth; there are colicky pains in the abdomen, which are relieved by drinking a cup of coffee. Chamomilla produces a diarrhoea with hot, yellowish-green stool, looking like chopped eggs, and often mixed with bile, causing soreness at the anus, and having an odor of sulphuretted-hydrogen; it is especially worse towards evening; it is apt to occur during dentition. Chamomilla is here frequently followed by Sulphur, because both remedies produce the same stools with soreness of the stomach. If there is much tenesmus with these symptoms Mercurius is the remedy. If the stool is worse in the morning, and comes with a gush, we should think of Podophyllum. Chamomilla is an invaluable remedy in the lying-in room; it is in- dicated when labor pains begin in the back and pass off down the inner side of the thighs. There is great nervous excitement; the labor seems exceedingly painful, after the labor is over, the lochial flow seems to be dark and too profuse, and the after-pains are violent and intolerable. Chamomilla may be used in threatening abortion caused by anger, when the pains are of the character just described, and there is a flow of dark blood. Viburnum is useful in threatening miscarriage when these pains come down the lower part of the abdomen and go into the thighs. It will stop the pains, even if it cannot prevent the miscarriage. LECTURE XXIII. MELANTHACEiE. Melanthaceae. < Veratrum alb. Veratrum viride. Sabadilla. Mind. Abdomen. Circulation. Colchicum. I i. i3- Nerves. Abdomen. Fibrous tissues. Organs. From the Melanthacece we obtain the following medicines: Veratrum album, Veratrum viride, Sabadilla, and Colchicum. Of these drugs, I may say that I am pretty well persuaded that the Veratrum album and Veratrum viride are pretty well understood, and are, therefore, not easily misapplied. I am also well persuaded that Colchicum has not the place in practice it deserves. True, it comes to us from the allopathic school as a remedy highly recommended for gout. We ought not, however, from the exorbitant use of the drug by that school, to go to the opposite extreme, and neglect it as a remedy alto- gether. Colchicum. The symptoms of Colchicum I have arranged under four headings. The first, the nerves, includes typhoid conditions and debility. You must know that the drug tends to produce great prostration, and from this arises the great danger in administering it in large doses as a routine remedy in gout and rheumatism. While the paroxysms of pain may be relieved thereby, there is apt to be induced a condition of debility which runs the patient into other and new dangers. Let us see how we can use this effect of the drug under our law of cure. We find it indicated in debility, particularly in debility following loss of sleep; for instance, when one does not retire as early as usual in the evening, so that he is deprived of a portion of his accustomed sleep, and he awakens the next morning feeling tired and languid; he can 234 A CLINICAL MATERIA MEDICA. hardly drag one leg after the other; the appetite is gone; bad taste in the month and nausea are present. The debility, then, starts from or involves digestion as a result of loss of sleep. You can see how close this comes to the Nux vomica condition. The debility, however, is greater even than that of Nux vomica. There is, at times, an aversion to all foods; the odor of food cooking makes the patient feel sick; he becomes irritable; every little external impression annoys him; here it is pre- cisely like Nux vomica. As another form of debility or debilitating fever, we find Colchi- cum indicated at times in typhoid fever. Now, the position of Col- chicum in typhoid fever is between Arsenicum and Cinchona. First, we find that the patient's intellect is beclouded. Although his mind is befogged, he still answers your questions correctly, showing you that he is not in a complete stupor. Unless questioned concerning it, he says nothing about his condition, which does not seem dangerous to him. There is not that fearfulness, that dread of death, which characterizes some other drugs indicated in typhoid fevers. The pupils are widely dilated, and very imperfectly sensitive to light. There is a cold sweat on the forehead; here you will at once note a resemblance to Veratrum album. When the patient attempts to raise the head from the pillow, it falls back again and the mouth opens w7ide. You thus see how weak are the muscles in the Colchicum case. The face has a cadaverous appearance. The features are sharp and pointed, the nose looks as though it had been pinched or tightly squeezed, and the nostrils are dry and even black. The tongue is heavy and stiff, and is protruded with difficulty. In extreme cases it is bluish, par- ticularly at the base. There is almost complete loss of speech, and the breath is cold. There are often nausea and vomiting, the latter being attended with considerable retching. These symptoms are as- sociated with restlessness and cramps in the legs. Coming to the abdominal regions, we find the body hot while the extremities are cold. Tympanites is exceedingly well marked. Stools are watery and frequent, and escape involuntarily. These are the symptoms which lead y7ou to Colchicum in typhoid states. They greatly resemble those calling for Arsenicum and Cinchona. They resemble Arsenicum in the intensity of the debility and Cinchona in the tympanitic condi- tion. Colchicum seems to stand between the two, combining the rest- lessness and debility of Arsenic with the tympany of Cinchona. You will notice that the Colchicum symptoms are principally abdominal. Some of them suggest Veratrum album. You must, therefore, place COLCHICLM. 235 this remedy in your mind by the side of Colchicum that you may make the necessary distinction between the two. Carbo vegetabilis is allied to Colchicum in the coldness of the breath, in the tympany, and in the great prostration. But Carbo veg. seems to suit when there is giving out of the vital forces. The patient lies cold and almost pulseless. The pulse feels much like a slight ripple beneath the examining finger; there is no decided pulsation. The feet and the legs below the knees are cold, or there may be coldness of the knees and feet, the parts between them not being cold. Then the watery stool is not so characteristic of Carbo veg., the discharges being either absent or, if present, dark brown and horribly offensive. Next we come to the abdominal symptoms. The tympany and the diarrhoea have been mentioned already. In addition to these symptoms we have others which strongly point to the drug as a possible remedy in cholera. There are nausea and vomiting, the nausea seeming to be pro- voked by the smell of food. Whenever the patient sits up, the nausea and vomiting become worse. The matters vomited are watery and bilious. When dysenteric symptoms are present, the stools are fre- quent, watery and bloody, and contain shreds which were formerly supposed to be portions of the lining membrane of the bowels, but which are now known to be a plastic formation from exudation. Tenes- mus is violent, and is followed by spasm of the sphincter ani. If you have a case of dysentery with these symptoms, Colchicum will help you out. If there is tympany also, all the more is it indicated, being then far preferable to Ca7itharis, Mercurius or any other remedy in our materia medica. The third heading on the board is '' Fibrous tissues.'' This brings us to the consideration of the Colchicum in rheumatism and gout. Now, Colchicum has a special affinity for the fibrous tissues. I include under this term the tendons and aponeuroses of muscles, ligaments of joints, and even the periosteum. The swelling produced by it is either dark red or pale in color, with no particular tendency to suppuration, and extremely sensitive to touch, and with a strong tendency to shift from joint to joint. In rheumatism proper, Colchicum is indicated when it begins in one joint and travels thence to another, or in one side of the body and then flies to the other. The pains are worse in the evening. The joint is extremely sensitive to the slightest motion. The urine is dark red and scanty, just such as you would expect to find in gout or rheumatism. You will find such patients exceedingly irritable. Every little external impression, as light, noise or strong odors annoys them, 236 A CLINICAL MATERIA MEDICA. and pain seems to be unbearable. The only difference between these symptoms and those of gout is that in the latter the great-toe is in- volved, and that the paroxysms occur in the night. Sometimes we have metastasis of rheumatism or gout to the chest. Even then Colchicum may be the remedy. In valvular heart disease or pericarditis following rheumatism, it is indicated by violent cutting and stinging pains in the chest, particularly about the heart, with great oppression and dyspnoea. There is also the sensation as if the chest were being squeezed by a tight bandage. Colchicum stands almost alone in gout and rheumatism There are no remedies similar to it in action here. Colchicum is sometimes indicated in dropsy with suppression of urine. The dropsy is particularly liable to appear as hydrothorax. What urine does pass contains blood, and is almost as black as ink, and is loaded with albumen. Hence you see that it is indicated in dropsy, depending upon Bright's disease. Here it resembles, quite closely, Lachesis, which also has this black urine. It also resembles Terebinthina, which causes congestion of the kidneys with rupture of the fine capillaries, and consequent pouring out of blood into the pelvis of the kidneys. The urine contains tube-casts. It is smoky in appearance, and has a dirty pinkish deposit. Thus you have seen when Colchicum may be used in rheumatism, when in typhoid fever, and when in simple debility. The prostration which I spoke of as following the protracted use of Colchicum may be utilized in this wray: When after frequent acute attacks of gout the patient becomes greatly weakened. In affections of the heart Colchicum is closely allied to Spigelia. When Colchicum has been abused, Spigelia is the remedy to be used as an antidote. Veratrum Album. Veratrum album is not a difficult remedy to understand. It has been used since the days of Hahnemann for cholera Asiatica, cholera morbus and other abdominal affections. Its symptoms in this relation are well known, but unless you are careful you will neglect an equally important use of the drug, and that is in mental symptoms. In poisoning with Veratrum, there are very few symptoms referable to the brain. It seems to act prominently on the abdominal organs, acting probably through the splanchnic nerves. When these nerves are paralyzed, the bloodvessels become over-charged with blood and pour forth their serum. veratrum album. 237 In this respect it is similar to Elaterium. The prostration, the coldness and the terrible sinking sensation that belong to Veratrum all start from these nerves. But Veratrum may affect the brain as well. Even then the symptoms are not unlikely to be associated with coldness, weak- ness, etc. We may have Veratrum album indicated in delirium. That you should notice particularly, as, in this respect, it becomes closely allied, apparently, to Belladonna. The delirium is associated wTith restless- ness, with desire to cut and tear the clothing, loquacity, and rapid, earnest, loud talking; he strikes those about him; anxiety; frightened at imaginary things; lasciviousness; lewdness in talk; he springs out of bed and rushes about the room as if thereby to obtain relief. Thus far the symptoms are such that you can with difficulty only distinguish them from those of Belladonna and Stramonium. The distinction lies here: Veratrum album has coldness of the surface of the body with cold sweat on the forehead. Sometimes the face is red and the lips are blue, and there is tingling through the limbs. Veratrum alburn is also suitable for women when they seem to have abnormal mental impressions arising from disturbance in the sexual sphere; in nymphomania, for instance. The patient is lewd to an extreme. She rushes about the room endeavoring to kiss every one. These attacks are especially prone to appear before each menstrual period. She is constantly framing lies of the most outrageous character. Veratrum is also to be thought of when after fright, there is great coldness of the body with diarrhoea. Gelsemium also has diarrhoea after fright. Under Veratrum, it is associated with coldness and pros- tration. Now for some of the abdominal symptoms. Veratrum album is indicated in affections of the bowels, in cholera morbus, cholera infan- tum and cholera Asiatica and in intussusception of the bowels. The stools in the diarrhoea calling for Veratrum are profuse, watery and greenish, containing sometimes little flakes that look like spinach. At times, too, they are bloody, and are always associated with sharp cutting pains in the abdomen, and often, too, with cramps in the limbs. There is great weakness and almost fainting with every effort at stool. There is very little copious, frothy vomiting. Cold sweat on the fore- head is present. In the various choleraic affections more particularly, Veratrum is in- dicated by the following symptoms: Vomiting and purging at the same time, colicky pains through the abdomen with cramps, especially in the 238 A CLINICAL MATERIA MEDICA. calves of the legs, profuse watery stools, ricewater stools as they are called. They are attended with great prostration and cold sweat, es- pecially on the forehead. It is useless to give Veratrum in choleraic affections unless there is pain. The patient is worse at night. Emaci- ation is rapid. The first remedy to consider here in its relation to Veratrum album is Camphor. Like the former remedy7, it produces coldness and symp- toms of collapse. Camphor is better suited to cholera when the dis- charges are scanty and the nausea marked. Sometimes the upper lip will be drawn upwards, showing the teeth, making the nauseous ex- pression of the face more hideous. The entire body is cold. The voice is squeaky or high-pitched. fatropha curcas produces an even closer picture of cholera than does Veratrum. It causes vomiting of ropy albuminous matters with purg- ing. Podophyllum resembles Veratrum album, in that it produces a per- fect picture of cholera morbus. It is especially indicated when the case is characterized by absence of pain. Herein, it is very different from Veratrum. The attacks generally come on during the summer. The stools are wateryT and come out with a gush and a splutter like water from a hydrant. There is marked loathing of food. The bowels are more apt to move after midnight and towards morning. The stools are very liable to vary in color, now yellow, now green, etc. There is a remedy which is, I think, better suited to the summer complaint of children than is Veratrum. I refer to Iris versicolor. It produces marked inflammatory symptoms, with excoriated raw feeling at the anus. The patient is worse at two or three o'clock in the morn- ing. There are nausea and sour and sometimes bilious vomiting. The stools are either watery, or are yellowish-green and mixed with bile or oily particles. Pulsatilla is called for in after-midnight diarrhoea caused by a diet of pastry, etc.; or by eating ice-cream immediately after a meal. Croton tiglium comes in when the movements are yellowish or yel- lowish-green, pouring out with a rush or splutter, like water from a hydrant. They are provoked by every attempt to eat or drink. Elaterium- is the remedy for profuse watery stools when they are of an olive-green color. I have often found Veratrum album useful for cardiac debility fol- lowing acute diseases, when the heart muscles becomes so weak that the pulse is thread-like. The patient faints on moving. On lying down, VERATRUM VIRIDE AND SABADILLA. 239 the face is red; on sitting up, it turns deathly pale. Often you will find the hands cold and clammy. Veratrum Viride. Although the name of this drug is similar to that just considered, you must not reason thereby that it produces the same symptoms. Veratrum viride produces congestion of the base of the brain and of the upper portion of the spinal cord. It thus interferes with the function of the pneumogastric nerves. At first it seems to produce engorgement of the lungs, just such as we witness in the beginning of pneumonia. This is associated with a high degree of arterial excite- ment. If these symptoms go on unchecked, we have dizziness and faintness on attempting to sit up, nausea, cold sweat and orthopnoea, and in fact every symptom of paralysis of the heart from over-exertion of that organ. Thus you will see that Veratrum viride comes in as an in- valuable remedy in those violent congestions which precede pneumonia. It may even abort the whole disease. Veratrum viride also produces oesophagitis, in which disease it may be indicated even when the disorder has arisen from traumatic causes. It is called for by the difficulty of swallowing and the fiery burning pains in the oesophagus. In chorea it is also indicated, when, in addition to the choreic twitchings, there is violent congestion of the nerve centres. Given in a low potency it relieves the congestion, and therefore the nervous disturbances. We may even depend on Veratrum viride in puerperal convulsions. The cerebral congestion is profound. The patient lies in a condition like that of apoplexy. Between the convulsions she is not conscious, but lies in a deep sleep. The face is red, the eyes are injected and there is violent convulsive twitching. In some cases Gelsemium helps when there is a dull, drowsy state of mind. Sabadilla. Like Veratrum album, Sabadilla is a useful remedy on account of its mental symptoms. It may be used with success in cases of imag- inary disease. For example, the patient imagines that she is pregnant when she is merely swollen from flatus; or that she has some horrible throat disease which will surely end fatally. Thuja has the symptom, imagines herself double or treble, or that 240 A CLINICAL MATERIA MEDICA. she is made of glass, and is in constant fear of being touched lest she be broken. Sabadilla is useful in influenza. There are violent spasmodic sneez- ing and lachrymation on going into the open air; the throat also is affected, giving you a perfect picture of tonsillitis. The difficulty begins on the left side, and extends to the right; the pain is worse on empty swallowing. Sometimes there is a sensation as of a thread or string in the throat, or else a sense of constriction in the throat, as if it was tied by a string. We may also make use of Sabadilla in worms, when there are nausea and vomiting associated with a peculiar colic, as though the bowels were being whirled around like a wheel. LECTURE XXIV. MENISPERMACEiE. The Menispermacece is not a very large order of plants, there being derived from it but one remedy that we shall consider in this course of lectures. That remedy is Cocculus Indicus. The name given to the order has been derived from the shape of the seeds. Cocculus Indicus. Cocculus Indicus owes its properties to an active principle called Picrotoxine, this term being derived from two words meaning, when combined, "bitter poison." You will notice by the schedule on the board that I have arranged the symptomatology of the remedy under two heads, first the nerves, and secondly, the organs in general. r i Cocculus Indicus. \ I I Now, whatever individual characteristics you may have for a drug in an individual case, these characteristics should agree with the gen- eral effects of the drug; otherwise, you are making a partial selection. To illustrate: Under Belladonna, you know of the symptom, "sleepy, but cannot get to sleep;" that is characteristic of the remedy. But we find the same symptom under Cinchona, Ferrum, and Apis. How are you to distinguish between them? By taking the general effect of Belladonna as a groundwork, into which the particulars must fit. Now, we shall find under Cocculus symptoms that are under many other drugs, but in no other drug do they hold the same relation as they do here. What, then, is the general effect of Cocculus Indicus f This effect is the well known action of the drug on the cerebro-spinal system, it having very little influence on the nerves and the ganglionic 16 i. Nerves. 2. Organs. Cerebro-spinal. Debility. Typhoid. Spasms. 242 A CLINICAL MATERIA MEDICA. system. How can you find this out ? Not very easily, I confess, but yet this has been done, by studying the drug as a whole, by endeavoring to discover, by means of physiology, pathology, or any other science that bears on the subject, on what portions of the body it acts, what functions it alters, and what tissues it changes. Then you have a strong basis on which to build your symptomatology. Cocculus acts on the cerebro-spinal system, producing great debility of these organs; the action of the drug on the brain itself I will ex- plain to you when I come to speak of its use in typhoid fever. We will now consider the remedy as it affects the spinal cord. It causes a paralytic weakness of the spine, and especially of its motor nerves; thus we find it a certain or frequent remedy in paralysis originating in disease of the spinal cord. Especially is it indicated in the begin- ning of the trouble, whether it results from functional or from severe organic disease of the cord; whether the disease be spinal irritation from loss of seminal fluid, softening of the spinal cord, or locomotor ataxia. It is especially indicated in these cases when the lumbar region of the spine is affected; there is weakness in the small of the back, as if paralyzed; the small of the back gives out when walking. There is weakness of the legs; and by legs I mean the entire lower extremities; the knees give out when walking; the soles of the feet feel as if they were asleep; the thighs ache as if they had been pounded; first one hand then the other goes to sleep; sometimes the whole arm falls asleep, and the hand feels as if swollen. These symp- toms lie at the foundation of the symptomatology of the whole drug; they all seem to depend upon spinal weakness. We find these symp- toms common enough in women with menstrual difficulties, when the back gives out in the morning, after veneral excesses, and also from loss of sleep. There is a concomitant symptom which you almost always find associated with those just mentioned, and that is a feeling of hollow- ness in some one of the cavities of the body, either in the head, chest, or abdomen. It is more than a weakness; it is an absolute feel- ing as though the parts were hollow. Talking tires these patients very much. The debility of Cocculus is of spinal origin. Especially is it apt to follow loss of sleep; the patient cannot sit up even one or two hours later than usual in the evening without feeling languid and exhausted throughout the entire day following. Let me next enumerate the typhoid symptoms of Cocculus; under this heading I shall speak of those of the brain. You would not COCCULUS INDICUS. 243 expect Cocculus to be indicated in a case of typhoid fever when the changes in or ulceration of Peyer's patches are marked, or where there are profuse diarrhoea, pneumonia, and similar complications. But in the nervous type of the fever, when the cerebro-spinal system is bearing the brunt of the disease, Cocculus becomes one of the reme- dies that will help us through the case. The symptoms indicating it are the following: The patient complains of great vertigo, and this is made worse when sitting, or when attempting to change from a re- clining to a sitting posture. It is often associated with nausea, inclina- tion to vomit, and even fainting. Bryonia also has this symptom. So far as the symptom itself is concerned, there is no difference between Bryonia and Cocculus, yet, if you examine the case thoroughly, you will find that in Cocculus it is weakness of the cerebro-spinal nerves that gives origin to it. There is great confusion of the mind; a sort of bewildered, heavy state might better explain what I mean. It re- quires a great effort to speak plainly. In some cases they cannot find the words they wish to convey their meaning. Generally, such patients lie quietly wrapped in thought; the eyelids are heavy, as though they could hardly be lifted. Here is a symptom reminding you of Gel- semium. If the patient is still conscious enough to describe to you his condition, he will complain of a feeling of tightness of the brain, as though every nerve in the head were being drawn up tightly. At other times, he has this empty, hollow, vacant feeling in the head. Any attempt to move the patient produces faintness or even fainting away. The tongue is usually coated white or yellow; there is bitter taste in the mouth. The abdomen is greatly distended and tympanitic; this tympanites under Cocculus is not the same as under Cinchona, Carbo veg., Colchicum, Sulphur, or even Lycopodium. There are several origins of tympanites. It may come from the bloodvessels, from the air swallowed with the food, from changes in the food itself, and also from retention of flatus. The latter condition is the cause of the tympany under Cocculus Indicus. It is not to be thought of as a remedy when flatus results from decomposition of food. That calls for Carbo veg. Cocculus has considerable oppression of the lungs, this being of nervous origin. It is usually referred by the patient to the walls of the chest. The patients are sleepless, or at least business thoughts crowd on the mind and keep them in a half-waking state, here again resembling Bryonia. These are the symptoms which lead you to Cocculus Indicus in typhoid states. The next division for consideration is '' Spasms.'' Cocculus Indicus 244 A CLINICAL MATERIA MEDICA. is useful in spasmodic affections when the patient is greatly debilitated as to the cerebro-spinal nervous system. Irritable weakness is the con- dition which gives rise to the spasms, for which Cocculus is the remedy. It is especially useful when spasmodic symptoms ensue as a result of prolonged loss of sleep. This condition we meet with more frequently in women than we do with men. The former are also more subject to spinal weakness. You may also use Cocculus for spasms after sup- pressed menses. The eyes are usually closed during these convulsions, and there is rapid oscillation of the eyeballs beneath the closed lids. But the woman must be of a weak, nervous temperament, or Cocculus is decreasingly indicated. Under the heading '' Organs'' we still have a word to say about Cocculus. First, as to the headache. Some years ago there was an epidemic of spotted fever in this city. During that epidemic many children died, especially in its earlier days. After a while there was discovered a symptom characteristic of the epidemic, and that was in- tense headache in the occipital region, in the lower part of the back of the head, and in the nape of the neck. The intense headache was manifested in various ways. Children in a stupor would manifest it by turning the head back, so as to relieve the tension oa the membranes of the brain; others, who were conscious, would put their hands to the back of the head; while still others complained of pain in the back of the head, as if the part were alternately opening and closing. That symptom was under Cocculus. There were very few fatal cases after Cocculus was used. Occipital headaches are hard to cure. Cocculus is a good remedy. Gelsemium is another. In the latter there is pas- sive arterial congestion, by which I mean that the arterial blood flows freely to a part, the pulse being full and round, and not hard and tense, as under Belladonna or Aconite. There is often thick speech, too, with Gelsemium. Still another remedy for occipital headache is the Juglans cathartica, sometimes called Juglans cinerea, or the butternut. This I consider to be the best remedy for sharp pains in the occipital region. We have already anticipated some of the symptoms of Cocculus pertaining to the female genital organs. Still there are others. The menses are either profuse, and coming too often and with a gush, and very debilitating, or they are tardy in their appearance, and the patient suffers each month from what has been termed menstrual colic. We have a little group of remedies, of which Cocculus is one, for this condition. The others are Pulsatilla and Chamomilla. First let me COCCULUS INDICUS. 245 describe the symptoms of Cocculus. This remedy is indicated by a colic, in which the pain is as if there were sharp stones rubbing against each other in the abdomen. There is very often with this colic excessive distension of the abdomen from accumulation of flatus. The colic is especially liable to come on at midnight and awaken the patient. It is re- lieved by belching, but returns again from the re-accumulation of flatus. The patient is, of course, irritable. Under Chamo77iilla the menstrual flow is very dark. The mental symptoms described to you in my lecture on that drug are necessarily present. Pulsatilla has scanty menstrual flow, coming by fits and starts, grip- ing pains doubling the patient up; but the disposition is mild and tear- ful. Cyclamen is similar to Pulsatilla. It has chilliness with the pains; crying, tearful mood; dyspepsia, made worse by eating fat food and pastry; scanty menses; menstrual colic. But we make the distinction here: Cyclamen does not have relief in the cool air or in a cool room, and in many cases Cyclamen has thirst. The resemblance between Cocculus and Cyclamen is that both remedies suit a depressed condition of the cerebro-spinal nervous system. Those of Cyclamen are these: The patient feels dizzy; is weak from any motion; is highly anaemic; and usually worse when sitting up. These symptoms are usually asso- ciated with dimness of vision. We also find under Cyclamen this flatu- lent colic, arising of wind in the bowels, coming on at night, and only relieved by getting up and walking about. Compare also, in menstrual colic, Ignatia and ATux vomica. LECTURE XXV. PAPAVERACE^E. WE now7 proceed to study the Papaveracece, an order of plants from which we obtain Opium, Sanguinaria Canadensis, and Chelidonium majus. As an order, they act on the circulation of the blood, tending to produce narcosis of a greater or less degree by exciting a fulness of the bloodvessels of the brain. The effect thus produced on the sen- sorium ranges all the way from sleepiness to stupor. This, you know, is eminently true of Opium, and, to a less degree, of Sanguinaria and Chelidonium. We will now take up the study of these drugs seriatim. Opium. ' Brain. Emotions. Spasms. Paralysis. Marasmus. Opium, j Constipation. Bladder. Sleep. Chest. Lungs. Heart. Defective reaction. Opium is obtained, as you probably know, from the unripe capsules of the poppy plant, Papaver somniferum. The unripe capsules are usually employed in its manufacture, because they give the most soporific effect. In some respects Opium is the most remarkable drug in our materia medica. You know that many drugs exert many of their effects owing to active principles which they contain. Thus Belladonna contains Atropine; Stramonium, Solanine; Nux vomica, Strychnine, etc.; but Opium seems to contain an endless number of these, and yet each succeeding year seems to add to the list. Let me enumerate them—they are as follows: Morphine. Protopine, Pseudo-morphine, Methylnornarcotine, Codeine, Deuteropine, Apocodeine, Laudanine, OPIUM. 247 Thebain, Codamine, Cotamine, Papaverine, Hydrocotamine, Rhoeadine, Apomorphine, Rheeagenine, Desoxymorphine, Dimethyluornarcotine, Nornarcotine, Mecondine, Thebenine, Cryptopine, Laudanisine, Narceine, Narcotine, Meconic acid, Lanthopiue, Lactic acid. These various alkaloids are derived from Opium, by more or less complicated processes. They all have more or less narcotic properties akin to those of Opium itself. The action of some of these alkaloids is well-know7n, while of the action of others we are as yet ignorant. Morphia (used principally in the form of the sulphate) is probably the best understood of these. It is largely used by old-school phy- sicians in hypodermic medication for the relief of pain. But we may make use of it as a homoeopathic remedy. In such violent diseases as cancer Morphia has been successfully given for one of its secondary symptoms, extreme susceptibility to pain; pains are so violent as to threaten convulsions, or cause twitching and jerking of the limbs; under these circumstances Morphia is a homoeopathic remedy. It does not cure, but relieves the pains, not as an opiate by stupefying the patient, but according to the law of homoeopathy. Morphia has the property of producing tympany. This is a very important fact for you to bear in mind, as you may find it necessary to differentiate incipient peritonitis from Morphia effects. Codeine, another of these alkaloids, is a useful drug in the treatment of phthisis. It is indicated in that dry, teasing cough which annoys the patient night and day. Furthermore Codeine has caused and cured twitching of the muscles, especially of the eyelids. This is a very annoying symptom; it is some- times relieved by Crocus. Apomorphia causes and cures vomiting. Now this vomiting is not of the kind for which you give Ipecac, Tartar emetic, Lobelia, etc. It is a reflex vomiting usually from the brain. Apomorphia produces vomiting if injected hypodermically, long before it can have any local action on the stomach. You may utilize this effect of the drug in vomiting of cerebral origin, and also in that annoying disease from 248 A CLINICAL MATERIA MEDICA. which many people suffer, and for which they get little sympathy, seasickness. In these cases of cerebral vomiting you may also think of Belladonna, Glonoin, and Rhus tox. There are several other of these alkaloids of which we have some provings, but nothing that has been definitely described. There are, also numerous preparations made from Opium; these are largely used in allopathic practice; we have nothing, however, to do with them, except to undo the mischief they produce. The various preparations of Opium enter into the composition of cough-mixtures and soothing- syrups, used largely in popular practice. Their effects are decidedly pernicious, especially in children. A prominent old-school authority says that the use of soothing-syrup for children is decidedly reprehen- sible. It stunts their growth, makes them irritable and cross, and interferes sadly with the brain development. Nux vomica is one of the antidotes in cases of injury from anodyne preparations. Still better, perhaps, as an antidote, is Chamomilla, which is suited when opiates have been given for some time, and have produced their sec- ondary effects; the little one is wakeful; slight pains are unbearable. When this condition is present, Chamomilla is your remedy, whether the patient be child or adult. No drug is more freely abused by both allopath and homoeopath (!) than is the one we are studying to-day. I would that I had both opportunity and ability to convince the practitioner of the old school of medicine of the absurdity of his indiscriminate use of opiates, and I could hope still more earnestly to dissuade homceopathicians from hiding their ignorance under the anodyne effects of an occasionally interpolated dose of Morphine or Laudanum. The one class ignorant of any other means of assuaging pains, and the other class too lazy to study their cases, seek relief for their patients in anodynes. Call them to task for their unscientific practice and they meet you with the re- mark, "My duty is to relieve the sick." Let me rejoin, "At any cost ? Must you do what you know to be wrong ? " " No, but how do you make it wrong ?'' Let me reply by a brief resume of the modus operandi of Opium, and then if this question is not answered I make no further objections to anodynes. In small doses, Opium has primarily a transient exhilarating effect. It seems, however, to affect the emotional more than the intellectual sphere. The mind feels as if floating in the air, unincumbered by the laws of space and gravity. The imagination has full play. If now the dose is increased, either in quantity or by frequent repetition, OPIUM. 249 there follows a sleepy state. This sleep varies all the way from a pleasant feeling of easy drowsiness to the most profound stupor. This narcotic and anodyne effect of Opium is the result of the increased circulation of blood in the brain. This it does, not only by increas- ing the amount of blood supplied to the brain but also by interfering w7ith its return to the heart. Let me digress for a few moments and speak of the physiological explanation of sleep. Hammond has shown that during this state, the quantity of blood circulating in the cranial cavity is greatly diminished. If you give Opium to produce sleep, what do you do? Do you produce anaemia of the brain? No, just the reverse. I ask you then, is the administration of opiates for their anodyne effects at all rational? Returning to the effects of Opium, the face becomes deep red and swollen from the distension of the bloodvessels. The more profound the stupor, the darker red is the face. It may even become of a brownish hue. The pupils become contracted. The pulse is full and slow. Respiration is deep, and as the stupor grows in intensity it becomes heavier and finally stertorous. What is the meaning of this stertor? It means that as the poisonous effects of Opium increase, a paretic and finally a paralytic condition of the muscles of the uvula and cheeks appears. These parts, thus being thoroughly relaxed, flap back and forth with each respiration. The pulse is full, round and slow, showing you that the heart is acting with the full volume of blood, but not with its usual speed. As the case goes on hour after hour, you find a picture of complete paralysis developed. The prac- tical application of this I will give you when speaking of typhoid fever. The sphincters lose their control, so that there is involuntary escape of urine and faeces. The lower jaw drops and finally death ensues. In these fatal cases autopsies show the cerebral convolutions to be flattened, the vessels of the cerebro-spinal axis engorged with blood, and effusion of serum beneath the arachnoid and in the ventricles of the brain. These are the symptoms of acute Opium poisoning. Now these phenomena depend upon the action of Opium on the nerves. From irritation comes the first brief excitation. From the subsequent paralyzing action come the drowsiness, muscular relaxa- tion and coma. From the beginning, the cerebral vessels are surcharged with blood, and this gradually increases until sopor ensues. Now, gentlemen, let me ask, is it rational practice to assuage pain with a sub- 250 A CLINICAL MATERIA MEDICA. stance which paralyzes and so relieves by taking away, not the disease, BUT THE ABILITY TO FEEL, THE CONSCIOUSNESS OF SUFFERING? What are the effects produced by the habitual use of the drug? The first effect is one that I have already described to you, one of dreamy imaginative activity of the emotional mind. Later, as the use of the drug is continued, every tissue of the body becomes affected. The skin grows dry and sallow and hangs in folds, the limbs emaciate, and the intellect becomes dulled. The best antidote to Opium is strong black coffee, given repeatedly until there is some sign of reaction. In addition to that you should use electricity. You should also remove any of the poison that may be in the stomach by means of an emetic or the stomach-pump, and you should force the patient to walk about to prevent stupor. Opium has been so far described that you can readily see in what classes of disease it is indicated. You see the picture of Opium in typhoid fever with profound cere- bral congestion resulting in paralysis of the brain, dropping of the lower jaw and stertorous breathing. Often when Opium is called for in this disease, the body is bathed in a hot sweat. This sweat is not critical. It is of bad omen. It is a symptom of approaching death in that it is a result of paralysis of the sweat glands. This symptom is also found under Stramonium. In typhoid fever with threatening paralysis of the brain, you should remember Lachesis, the symptoms of which I described to you when lecturing on that drug; also Hyoscyamus, which has the stertorous breathing; but there are differences, as you will learn in a future lecture. In one case where a profound coma failed to yield to Opium, Apis restored the patient. Opium must be considered in the treatment of apoplexy. It is quite natural to suppose that a remedy producing such fulness of the cere- bral bloodvessels might, in persons predisposed, readily cause their rup- ture, and the consequent symptoms of extravasation of blood into the cerebral substance. Opium is to be thought of by the color of the face, by the stertorous breathing, and by tetanic rigidity of the body. Especially is it indicated in the apoplexy of drunkards. Opium follows Belladonna in apoplexy. In apoplexy occurring in drunkards, you should also think of Baryta carb. and Lachesis. OPIUM. 251 Arnica suits in apoplexy when the pulse is full and strong, the paralysis is on the left side and there is stertorous breathing. Apis is called for when the coma fails to yield to Opium. For apoplexy with convulsions, think of Belladonna, Hyoscyamus, Lachesis and Opium. For apoplexy followed by paralysis, Arnica, Belladonna, Lachesis, Nux vomica and Rhus. When followed by idiocy, Helleborus. Opium is useful in mania a potu or delirium tremens. Especially is it indicated in '' old sinners,'' in those whose long lives of excess have thoroughly destroyed their constitutions; in those who have had the disease time after time. It takes but a small quantity of liquor to throw them again into the delirium. The face wears a constant ex- pression of fright or terror. They have visions of animals springing up from various parts of the room. They imagine that they see ghosts, devils, etc., with whom they converse, though they are terrified by the subjects of their visions. If they succeed in obtaining sleep, it is of the stertorous character already referred to. There are several remedies which, if given soon enough, will enable you to carry your patients with delirium tremens safely through the attack. I have already mentioned Opium; another is Lachesis; espe- cially is this indicated when the patients have visions of snakes and other hideous objects, sensation in the throat as if choking, and spring- ing out of sleep suddenly as if from a dream. Another remedy is Stramonium, to which you will be guided by the violence of the symptoms. The patient starts up from sleep in perfect horror, with visions of animals coming towards him from every corner of the room; he makes efforts to escape; his face is bright red. Still another remedy is Cannabis Indica, or the hashisch. This is one of the best. It has thus far been given only in low potency7. The symptoms which seem to characterize it are, errors of perception as to space and as to time. In other cases, we have to use Arsenic when there is fear of death and the patient will not permit himself to be left alone. A remedy often forgotten, but useful, nevertheless, is Calcarea ostre- arum. The minute the patient closes his eyes he sees visions compell- ing him to open them again in affright. You may use Opium in cholera infantum when the face is red or pale, and is associated with fatally advancing stupor; the pupils react either not at all to light or else very sluggishly. The disease seems to 252 A CLINICAL MATERIA MEDICA. begin by involving the brain; as yet there is neither diarrhoea nor vomiting; the child appears as if it had been drugged. Opium adminis- tered in a case like this will restore the patient to consciousness. Diar- rhoea sets in, and the disease proceeds naturally to recovery. This remedy may also be given when there is a lack of vitality anel the well- selected remedy refuses to act. The patient is either sluggish or drowsy. It is just as useful in these cases as are Carbo veg., Sulphur, Valerian, Ambra grisea, Psorinum, or any of the other drugs called for in defec- tive reaction. In still other cases of cholera infantum, Opium is indicated when, after the diarrhoea has lasted awhile, stupor sets in. There is a remedy which I wish to give you here, but with some caution, because it is what has been termed a breech-presentation, that is, it was used clinically before provings of it were made. That remedy is Ferrum phos. It is called for in cholera infantum when the discharges from the bowels are frequent; within twenty-four hours the child is greatly reduced, and falls into a stupor, with red face, dilated pupils, rolling of the head, and soft, full-flowing pulse. We know that Iron has that kind of a pulse; we know that congestion belongs to all the preparations of Iron. In one of my cases with the above symptoms, Belladonna and Sulphur were each given in turn, but failed. I then gave Ferrum phos., and in twelve hours the child returned to consciousness, and is alive to-day. You may also use Opium in suppuration of the lungs occurring in those greatly addicted to the use of intoxicating liquors; breathing is labored, and is attended with rattling and snoring. Cough is very difficult, and is attended with smothering spells; the face becomes blue during the cough. Another affection of the lungs occurring in drunkards, namely, haemoptysis, calls for Opium when the chest is hot and the limbs are cold; the cough is violent, and is attended with an expectoration of frothy mucus and blood; the patient is drowsy with the cough. Antimonium tartaricum also has cough with drowsiness and gaping. We find Opium sometimes indicated in spasms, especially when they occur as the immediate result of fright or anger; or when a nursing infant has a convulsion after its wet-nurse has been frightened; the body is in a condition of tetanic rigidity; the spasm is ushered in with a loud shriek; there is foaming at the mouth; the face becomes dark red, or even purple, and the body is often bathed in a hot sweat; deep, snoring sleep follows the spasm. Opium causes and cures constipation; a constipation in which there OPIUM. 253 is inertia of the rectum and the entire intestinal tract; there is no in- clination wrhatever for the bowels to move; thus the bowels become impacted with faeces; flatus accumulates in the upper portion of the intestines and presses upwards against the chest. This symptom is very common after diseases that are debilitating or long lasting. In such cases I have been in the habit of giving Opium in repeated doses until colicky pains are produced; this indicates restoration of peris- taltic action of the bowTels. I then order an injection of cocoa-nut oil or soap and water to soften down the faecal masses, when an easy evacuation of the bowels follows. The Opium stool in its complete picture consists of little hard, dry, black balls. This form of consti- pation reminds us of that of Alumina, Plumbum and Bryonia. Bryonia has constipation with inertia of the rectum; the stools are large and dry. Plumbum closely resembles Opium, but there is some spasmodic con- striction of the anus; the stools consist of hard black balls. Alumina has inertia of the rectum with hard, dry, knotty7 stools, but often attended with soft faeces. In tympanites or accumulation of flatus, compare Opium with Tere- binthina, Lycopodium, Carbo veg., Colchicum, and Raphanus. The characteristic symptom calling for the last-named remedy in tympanites is, that the patient passes flatus neither upwards nor down- wards for days. Opium may be used in bladder troubles, especially in retention of urine. It is indicated when this retention has resulted from fright, and when it follows parturition. This last-named symptom I have twice confirmed. In this retention of urine after labor, compare with Opium, Hyoscy- amus, Causticum, and Arse7iicum. In suppression of urine you may think of Stramonium, Zingiber, Lycopodium, and Pulsatilla. The power of Opium to cause shrivelling of every fibre of the body suggests its use in marasmus in children. The patient is wrinkled and looks like a little dried-up old man; the characteristic Opium stupor is present. When the above-named condition has been produced by Opium, Sulphur, Argentum nitricum, or Sarsaparilla may be used as an anti- dote. Muriatic acid is the remedy for the continued muscular debility following the use of Opium. We ma}7 find Opium indicated in that very dangerous condition, 254 A CLINICAL MATERIA MEDICA. strangulation of the bowels. There are violent colicky pains and vom- iting of matters having a faecal odor. In colic, it may be given when there is great tympany; there is a great deal of belching without relief. Sometimes we find Opium useful in metrorrhagia, whether after labor or not. The patient is restless; the sheets feel hot to her; she is sleepy, but cannot sleep. In fevers other than typhoid, it may be given when the chill is accompanied by heat of the head and great drowsiness; the body is burning hot, even when covered with a copious sweat; desire to un- cover; unconsciousness; feels as if his legs belonged to some one else. (Comp. Baptisia and Stra7nonium.) Puerperal fever sometimes calls for Opium, especially when caused by fright. There is overexcitement of all the senses; even distant sounds annoy the patient; the discharge from the uterus is very foetid. The case approaches a condition of stupor. In haemorrhage from the uterus, compare Belladonna, which has a flow of bright blood feeling hot to both physician and patient. Hyoscyamus also has this. But under this remedy there is a great deal of spasmodic jerking of the body. You will see from what I have said that Opium is an invaluable remedy for the bad effects of fright, whether that emotion produces con- vulsions or diarrhoea. Gelsemium, Pulsatilla, and Veratrum, you will recall as being useful in diarrhoea after fright. For the chronic effects of fright, you should xemember Natrum mu- riaticum, Silicea, and Phosphoric acid. Opium, like Bovista and Arnica, is useful for the bad effect of in- halation of charcoal vapors. In spasms of the lungs, compare Moschus and Ipecac. Drosera is likewise indicated in the spasmodic cough of consumption, coming on in the evening, perhaps again after midnight. Every effort to raise a little phlegm ends in retching and vomiting. LECTURE XXVI. SANGUINARIA AND CHELIDONIUM. Before proceeding with our study of Sanguinaria, I will say that there is a variety of the poppy plant which grows in Mexico called the Argemone Mexicana. It is used in Mexico in much the same manner as we use Opium. It causes cutaneous eruptions and has been used in the expulsion of tape-worm. The juice of the plant when collected and dried has much the appearance of gamboge. I mention this, not because it is a matter of importance, but as a piece of information that may in time prove beneficial. We will now take up the study of another member of the Papaver- aceae, the Sanguinaria Canadensis, or blood-root. This is a plant which is readily recognized by the character of its root, which, when cut is red, and exudes a fluid having the appearance of blood, hence the plant has been aptly named " blood-root." The seeds of Sangui- naria are somewhat narcotic. You can see a resemblance between it and Opium, not in the completeness of its symptomatology, but a family resemblance sufficient to place it by the side of Opium, yet having differences so great that there can be no danger of confound- ing the two drugs. In extreme narcosis from Sanguinaria we find languor and torpor, dilated pupils, with disordered vision and irregu- lar pulse. The symptoms are not unlike those which follow poison- ing with Stramonium. In studying the drug we may save all un- necessary multiplication of symptoms by the attention to the following schemae: Belladonna, ^ Iris versicolor, Paullinia, Melilotus, Compare with Sanguinaria Canadensis, In headache. J Veratr. viride, Phosphorus, Antim. tart., Sulphur, In pneumonia. 256 A CLINICAL MATERIA MEDICA. Sanguinaria Canadensis irritant to -^ ' Brain: Anxiety, irritability. Nose: Faint from odors. Ears: Sensitive to sudden sounds. Headaches. Vertigo. Haemorrhages. Climaxis. Fever. Menstruation. Phthisis fluorida. Local congestions. Circulation. Mucous membranes: ■> Dry feeling or rawness. Cough. Croup. Ulceration. Polypi. Diarrhoea. Pneumonia. Glands: Salivation. Skin: Acne, ulcers. Muscles: Rheumatism, myalgia, languor, nausea, faintness. Sanguinaria is in the first place an irritant, whether taken into the mouth, applied to the skin, or when carried by the blood to other tis- sues. For the primary and most important effect of the drug, then, we have irritation of tissue. For instance, the brain is irritated by San- guinaria. This is mentioned first because of the predominant impor- tance of all mental symptoms, be they emotional or be they intellec- tual. Anxiety is almost always present with the Sa7iguinaria symp- toms. This anxiety, however, is not an isolated symptom. It appears qualifying the headaches, the gastric difficulties, the heart and chest symptoms, and in fact all the ailments in which Sanguinaria is ap- plicable. Like almost all anxiety, it is accompanied by irregularities or disturbances in the circulation. There is also an irritability of temper which makes the patient morose, irritable, peevish or excitable. SANGUINARIA. 257 Then we note, too, that the ears are irritated by the drug. Primarily, this irritation comes from the irritating action on the circulation. It causes increased redness of the external ear, with humming and roar- ing in the ears from increased circulation of blood through the aural structures. It also produces a hyperexcitation of the auditory nerves with the following symptoms as characteristic: Painful sensitiveness, especially to sudden sounds; sensation as if the patient were in a rail- road car or in some vehicle which was moving and jarring her. with ^ a feeling as if all about her were talking rapidly and confusedly; the patient desires to be held in order to remove this nervous vibratory sensation through the body. Thus you see the primary irritating effect on the ear reflected through the entire nervous system producing these symptoms, which, by the way, are not uncommon in women about climaxis. Sanguinaria is equal to Glonoin in these cases. This desire to be held reminds one of Gelsemium, which has heart disease with tremor of the whole body and desire to be held still. Next we come to the nasal symptoms. The sense of smell is usually increased; hence we notice a peculiar susceptibility to odors, which causes the patient to feel faint. This is not an uncommon symptom in " rose-cold." It also belongs to hysteria, and places Sanguinaria by the side of Phosphorus, Ignatia, Valerian, Nux vomica and similar remedies. Next we come to the disturbances in the circulation. We find these first exhibited in the vertigo, there being a rush of blood to the head with this dizziness; the patient feels sick and faint, as if she would fall when she attempts to rise from a sitting posture. Then, too, we have the circulatory disturbances represented in the sick-headache, and Sanguinaria has no equal in sick-headache, espe- cially in that form which is so common in this country as to receive the name of "American sick-headache." The patient suffers from rush of blood to the head, and this causes faintness and decided nausea, the nausea even continuing until vomiting sets in. The pains, which are of a violent character, begin in the occipital region, spread thence over the head, and settle over the right eye. They are of a sharp, lancinating character, and at times throbbing. At the height of the disease the patient can bear neither sounds nor odors. Mark the effect on the auditory and olfactory nerves. She can not bear any one to walk across the floor, for the slightest jar annoys her. As the head- ache reaches its acme nausea and vomiting ensue, the vomited matters consisting of food and bile. The patient is forced to remain quiet in a darkened room. The only respite she has is when sleep comes to 17 258 A CLINICAL MATERIA MEDICA. relieve her. Sometimes the pain is so violent that the patient goes out of her mind, or she seeks relief by pressing against her head with her hands or by pressing the head against the pillow. This is the Sangui- naria sick-headache in its completeness. Not only does the remedy palliate, but it cures. Studying Sanguinaria with its concordant remedies, you will find coming into your mind most prominently Belladonna as affecting the right side, as having throbbing pains, cerebral congestion and intoler- ance of light and noise. You see that the two remedies are very similar. Practically speaking, Sanguinaria is the more useful of the two in the gastric form. In Belladonna, you almost always find cold feet with the hot head, which may not necessarily be present under Sanguinaria. Then again, the Belladonna patient is not relieved by lying down, but by sitting propped up, while Sanguinaria has relief from lying down. Then Belladonna has not so characteristically as Sanguinaria the direction of the pains; that is, the " pain coming from the occiput over the head, etc.," is not quite so prominent under Bella- donna as it is under Sanguinaria. Melilotus, one variety of the clover, produces a most violent cerebral congestion with headache, which drives the patient almost frantic. It really seems to the patient that the brain would burst through the fore- head. The throbbing pain is almost as violent as it is under Glonoin. In one proving of this drug, a lady had this congestive headache with prolapsus uteri and violent palpitation of the heart. Still another drug closely allied to Sanguinaria is Iris versicolor. This drug is useful for sick-headaches, particularly when they are periodical in their appearance, recurring, for instance, every Sunday. This is because the strain of the preceding six days has been relieved and now the patient feels the effects of the strain and has this sick- headache. It is especially suited to school teachers, college professors, students, etc. The pains are intense and of a throbbing character and supra-orbital. They often affect the eyes and cause temporary blind- ness. At the height of the headache vomiting often ensues, the vomited matters being bitter or sour, or both. I wish also to mention Paullinia sorbilis. This has some little his- tory. A number of years ago there appeared a specific, in the form of pills, for sick-headache, the principal ingredient of which was this Paullinia. It proved itself to be an efficacious remedy. The objection I have to the drug is that it must be given in large doses, consequently I do not think that it has a true symptomatic relation to the ailment for which it was recommended. Its active principle is said to be identical with Caffeine and Theine. SANGUINARIA. 259 Continuing our study of the effects of Sanguinaria on the circula- tion, we find it sometimes indicated for haemorrhages, not very fre- quently it is true, yet when the symptoms call for it you should bear it in mind. It is especially indicated in metrorrhagia occurring at climaxis. The blood is bright red, clotted and frequently offensive. Especially is it to be used when the metrorrhagia is accompanied by the form of sick-headache which I have already described, and by flushing of the face and flushes of heat which are incident to change of life in women. The face becomes scarlet. This high color passes off with moisture and faint, weak, sick feeling. Here then you must place Sanguinaria with Glonoin, Nitrite of Amy I, and Lachesis. The menstrual flow of Sanguinaria is bright red, clotted and offensive, later becoming dark and losing its offensiveness. Still another fact which illustrates these irregularities of the circu- lation, is the application of Sanguinaria to phthisis florida. In detail- ing to you the symptoms calling for this remedy in phthisis florida, I will also mention the character of the cough and also the application of the drug in pneumonia, because the symptoms in each case are sim- ilar although belonging to different diseases. You find the patient suffering from hectic fever. The fever usually comes at about two or four o'clock in the afternoon; the cheeks have a bright circumscribed flush. The cough is usually dry at first, and seems to be excited by tickling or crawling in the larynx and upper portion of the chest, probably in the trachea, and perhaps in the beginning of the bronchial tubes. There is a great deal of burning and fulness in the upper part of the chest, as if it were too full of blood, which it really is. The patient complains of sharp stitching pains, especially about the right lung and in the region of the nipple. These pains are in all proba- bility7 myalgic. The muscles of the chest are, of course, sore with this pain. There is also great dyspnoea. Thus early in the disease, San- guinaria, by calming the circulation, by removing the congestion of the chest, by lessening the hectic fever, will save your patient from what would end fatally in a few months. When pneumonia calls for Sanguinaria, we have, in addition to the symptoms already mentioned, rust-colored sputum with the cough (just as you find in the stage of red hepatization), a very distressing amount of dyspnoea, and the hands and feet burning hot, or else just the reverse, cold. Sometimes, even before the amount of hepatization will account for it, you have failure of the heart's action. The heart becomes weak and irregular in its action. There is a weak, faint feel- 260 A CLINICAL MATERIA MEDICA. ing about the heart. The patient is faint. He is covered with sweat and he suffers from nausea. Localized congestions are frequent enough in the symptomatology of Sanguinaria. You have seen how it causes cerebral congestion, circumscribed redness of the cheeks, etc. You may also use it for a teasing cough compelling the patient to sit up at night. The cough ceases so soon as the patient passes flatus by the bowels. Connected with this form of cold, there is a feeling as of a warm current running from the chest to the stomach. The disease may be transferred from the chest to the abdomen, the whole difficulty ending in diarrhoea. Sanguinaria resembles several drugs in pneumonia. It bears a re- semblance to Veratrum viride in the engorgement of the lungs and in the intensity of the symptoms. Veratrum viride has, more marked than Sanguinaria, arterial excitement. As yet, hepatization has not taken place. Veratrum viride given then lowers the pulse, reduces the congestion and modifies the pneumonia. It also resembles San- guinaria when the engorgement is so profound as to threaten the death of the patient. The pulse becomes rapid and quivering, the face livid, and every symptom of approaching paralysis of the lungs is present. When hepatization has taken place, Veratrum viride is not indicated. Phosphorus resembles Sanguinaria in pneumonia. Its symptoms I will mention when I lecture on that drug. Antimonium tartaricum resembles Sanguinaria when the face be- comes livid, the blood is surcharged with carbon, rattling cough, etc. Sulphur resembles Sanguinaria during the stage of resolution when the hepatized lung does not clear up properly, and the sputum becomes purulent. In these cases, either remedy is indicated, Sangui- naria being preferable when the expectoration is very offensive, even to the patient himself. Returning to Sanguinaria and reviewing its action on the mucous membranes, we find that it has a highly irritating effect, causing at first extreme dryness, whether it be the conjunctiva, the mucous membrane of the mouth, nose or any other mucous surface. Alternating with this dryness and indicating the drug in another phase of the case, is rawness with burning, as though the mucous membrane was denuded of its epithelium. This is common enough in catarrhs. You find the nose sore and raw with fluent excoriating coryza. The cough is as I have described, and seems to depend upon this dryness or irritation of the mucous surfaces. When the laryngeal mucous membrane is affected, we have very dis- CHELIDONIUM. 26l tressing symptoms. There is aphonia and, in addition, a feeling of swelling in the throat as though the patient would choke. Sanguinaria is indicated in laryngeal catarrh, whether it be from phthisis or from simple cold or exposure. The croup for which we may use Sanguinaria is one in which there may be a formation of pseudo-membrane with dryness, burning and swollen feeling in the throat, and metallic croupy cough which cannot be characterized by any other words than wheezing-whistling. It is too shrill to be only " wheezing," and it is too moist to be " whistling " alone. If it is associated with the dryness and burning, and some of the other catarrhal symptoms, Sanguinaria will quickly cure the entire affection. Sometimes we have ulceration of the mucous surface with the quali- fying symptoms already mentioned. Another effect on the mucous surfaces is the formation of polypi. These may be found in the nose or in any other part of the body. San- guinaria is especially useful for mucous polypi when they bleed pro- fusely. When occurring in the nose, they are associated with the form of coryza already referred to. There is also prof use salivation, showing that the drug irritates the salivary glands. The skin is also affected under Sanguinaria. It produces acne on the face, particularly in women who have scanty menstruation and are subject to irregular distribution of blood. Lastly, we find the drug affecting the muscles, inflaming them, and giving a picture of acute muscular rheumatism. The pains are erratic, sharp and stitching, with great soreness and stiffness of the muscles, especially those of the back and neck. Sanguinaria exhibits a special affinity for the right deltoid muscle. The pains are intense. San- guinaria holds the same relation to the right deltoid that Ferrum does to the left. So much for Sanguinaria Canadensis. Chelidonium Majus. ' Liver, Lungs, Heart, Neuralgia, Toothache. Chelidonium. -j Eyes, Kidneys, Fistula. Joints, Diaphragm. Skin, Chills and Fever. 262 A clinical materia medica. Compare with Chelidonium majus, I will be brief in my remarks on Chelidonium, as we have not the time to exhaustively treat of the drug. It is a unique remedy, pos- sessing points of similarity with its congeners, Sanguinaria and Opium, and also to Nux, Mercurius, Phosphorus and Kali carb. The plant yields an acrid, yellow, bitter juice, which, when applied locally, pro- duces inflammation and even vesication. The principal value of Che- lidonium lies in its action on the liver, lungs and kidneys. The patient is low-spirited, inclined to weep, but knows no reason therefor; rest- less, must move from place to place, with mental anguish; headache, with coldness extending from the neck into the occiput; the head is so heavy he can scarcely raise it from the pillow; pressure in the occi- put towards the left ear. It may be indicated in many affections of the first-named organ from a simple congestion to a positive inflam- mation. It produces pains in the right hypochondrium all the way from a simple soreness to the most aggravating variety of sharp stitch- pains, which shoot from the liver down into the stomach, or down into the back from the posterior aspect of the liver. There is marked pain under the angle of the right shoulder-blade. That is the key-note for the drug in hepatic disease. In addition to this you have the usual hepatic symptoms, swelling of the liver, chills, fever, jaundice, yellow- coated tongue, bitter taste in the mouth, tongue taking the imprint of the teeth, as you find under Mercury, and desire or craving for milk, which exceptionally agrees. There is usually also a craving for acids and for sour things, as pickles and vinegar. The stools are character- istically profuse, bright yellow and diarrhceic, or they may be clayey. These are the symptoms of Chelidonium, and they are very definite. Let me tell you how to apply them. You may use the drug in simple biliousness; in hepatic congestion or inflammation, and also in pneu- monia with bilious symptoms, in what has been termed bilious pneu- monia. The symptoms indicating it in the latter affection I will give you presently. This pain, under the angle of the right scapula of Chelidonium, brings to mind pains of a similar character found under other reme- dies. Chenopodium has dull pain lower than the angle of the right scapula and nearer the spinal column. Mercurius. Kali carb. Bryonia. Lvcooodium. chelidonium. 263 Ranunculus bulbosus has pain along the whole inner edge of the left scapula, at times extending below its inferior angle and through the left chest. Lobelia syphilitica has pain under, not below, the inner border of the left scapula, worse after weeping. Angustura has sharp cutting pain from just beneath the right scapula to the breast, near the nipple. Bryonia is very similar to Chelidonium in hepatic affections. Both remedies have sharp stitching pains, both have pain under the right shoulder blade, both have bitter taste in the mouth and yellow-coated tongue and both have swelling of the liver. But Bryonia differs in its stool which is either hard, dry and brown or, if loose, it is papescent and profuse and associated with a colic very much like that of Colo- cynth. Sometimes the stools have an odor of old cheese. Lycopodium, which bears some resemblance to Chelidonium, is easily differentiated, especially in the rumbling of flatus in the left hypochon- drium, in the sour rather than the bitter taste, in the sour vomiting, in the fulsomeness after partaking of small quantities of food, and in the character of the pains, which are dull and aching under Lycopodium, and sharp and lancinating under Chelidonium. You may use Chelidonium in neuralgia of the face. The pains go from the right cheek bone into the teeth or into the eye, or the pain may be located in the supra-orbital nerves. This neuralgia will not yield to Chelidonium, however, unless you have some of the hepatic symp- toms of the drug present. It is a neuralgic dependent on disorder of the liver, and not an idiopathic prosopalgia. Chelidonium is useful, as,I have already intimated, in bilious pneu- monia. It is also indicated in the capillary bronchitis of children when these hepatic symptoms are present, especially when it follows measles in whooping cough. The face in these cases, is apt to be deep red. There is great oppression of the chest as shown by the efforts to breathe and the fan-like expansion of the alae nasi (a Lycopodium symptom, by the way) one hot and one cold foot (another Lycopodium symptom) and stitching pain under right scapula. The cough is usually loose and rattling. The expectoration is not easily raised. Mercurius is sometimes indicated in bilious pneumonia^ It differs from Chelidonium in the character of the stool more than in anything else. The Mercury stool is slimy and is attended with great tenesmus before, during and after the stool, while in Chelidonium it is quite free. The Mercurius expectoration is apt to be blood-streaked, and 264 A CLINICAL MATERIA MEDICA. there are sharp pains shooting through the lower portion of the right lung to the back. That last symptom may be in Chelidonium, too. Antimonium tartaricum has yellow skin, urine and vomit, etc, (in bilious pneumonia); stinging under right false ribs, frothy yellow tenacious sputum, rattling in chest with suffocation, fan-like motion of alae nasi, great oppression, strong heart beat. Kali carb. is a remedy often forgotten in pneumonia. It is not in- dicated in the beginning, but later, when there is copious exudation into the lungs, with great rattling of mucus during the cough. The symptoms are worse towards two or three o'clock in the morning. The expectoration contains little globules of pus. There may even be cyanotic symptoms with puffiness over either eyelid. LECTURE XXVII. CUCURBITACEiE. i. Colocynthis cucumis. 2. Bryonia alba. 3. Citrullus (Water-melon). The seeds are Cucurbitaceae. diuretic. 4. Cucurbita (Squash). 5. Momordica balsamina.—Flatulency. 6. Elaterium momordica.—Bowels and fever. To-day we begin our study of the Cucurbitacece. This order gives us some six or eight drugs, and also some edible substances. Among the latter are the water-melon, canteloupe, and cucumber. The seeds of some of these have diuretic properties, and those of the water-melon have been used as a cure for worms. Of the medicinal substances obtained from this order we may say that they all act prominently on the alimentary tract. They seem to have in common a cathartic action. They probably act paralyzingly on the vaso-motor nerves of the abdomen. They produce griping pains, gushing watery diarrhoea. This last symptom is most promi- nent under Elaterium. Let us now enumerate these medicines. Fifth on the list is the Momordica balsamina; of this we have but one characteristic symptom, and that is accumulation of flatus in the splenic flexure of the colon. It is a very convenient thing to know this. For instance, if, during the course of a more or less chronic disease, this one symptom becomes very annoying, and you do not want to destroy the action of the drug you are giving, you simply interpolate a dose of Momordica, which removes the symptom and enables you to go on with the treatment as before. Elaterium, another member of the order, has been used principally, in our school of medicine, in a peculiar form of diarrhoea. Like all the Cucurbitacece, it acts powerfully on the alimentary tract, producing a sudden and enormous effusion of serum into the bowels. Thus it causes a watery diarrhoea, the stools flowing out very profusely. The 266 A CLINICAL MATERIA MEDICA. characteristic symptom of the drug, and the one which will lead you to its selection in cholera infantum, is watery stools of an olive-green color, coming out with a gush. Thus, you see, it is comparable with Croton tiglium, Podophyllum, and Veratrum album, and remedies of that type. It is readily distinguished from Croton tiglium, which is adapted to a profuse, yellow watery stool, which is provoked every time the pa- tient eats or drinks. Podophyllum has, as you all know, the morning aggravation to dis- tinguish it. The remaining medicines belonging to the Cucurbitacecz are the Citrullus, or water-melon; the Cucurbita, or squash, the seeds of which, as well as those of the pumpkin, have been used for taenia; the Colocynth, and the Bryonia alba; the last two named being drugs of great importance; we will therefore proceed to their consideration in extenso. COLOCYNTHIS CUCUMIS. Colocynthis. i. Nerves. {Neuralgia. ( Cramp. 2. Bowels. 3. Urine. 4. Goui. The Colocynthis cucumis furnishes us with a gourd about the size of an orange with a smooth marbled green surface. When dried it appears of a brownish color. It is not indigenous to this country, but is imported from Syria and Turkey. Often, however, it is found in the market, pealed and dried, looking like a pithy ball, full of seeds and very light in weight. It is inodorous, but it has an intensely bitter taste. Like the other members of this group, Colocynth causes violent intestinal irritation, first watery evacuations and later of mucus and blood. The pains are atrocious, griping, cutting, etc. But this is not all. The drug also affects the nervous system powerfully, whence comes its beneficial effects in the treatment of various neuralgias. In its neurotic symptoms, Colocynth is closely allied to Dioscorea villosa. Furthermore, this remedy so long restricted to the relief of colic alone, has lately wrought cures in certain deep-seated ovarian diseases, as ovarian tumors. Colocynth acts directly on the ovaries, and also COLOCYNTHIS CUCUMIS. 267 upon the epididymis. It is a mistake to assert, as was done formerly, that it can cause no inflammatory action; for in a case of poisoning, the autopsy revealed freshly-glued intestines, thus showing an inflam- matory exudate. It is indicated in affections of the ovaries by stitching pains as from a needle deep in the right ovarian region, and crampy pains relieved by bending over or from pressure. Two cases of ovarian tumor have been reported as cured by Colo- cynth on these symptoms. I well remember having cured a lady from ovarian colic from which she had suffered for three years, with Colocynth. The pains in this case were of a griping character and were relieved by bending double. There were no organic changes present. Now let us examine the action of Colocynth on the abdomen and its contents with the concomitant symptoms: Persistent bitter taste; violent thirst; empty eructations; nausea; vomiting of a bitter fluid or of food; griping pains which force him to bend double or to press firmly against the abdomen. This griping is the well-known key-note of the drug, and it is indicatory whether it be of local origin or reflex, whether arising from flatus, undigested food, or cold; or whether resulting from violent emotions, as in what has been termed " nervous colic." The stools may be fluid, copious, faecal, flatulent and papes- cent; or slimy and bloody and preceded by severe tenesmus; but in every case there is this griping which more often precedes the stool and is relieved afterwards. Sometimes, however, it continues after stool. These evacuations are provoked by the slightest food or drink, as is also the pain. In some instances the griping develops into cut- ting, stabbing pains, which spread all over the abdomen and down into the pelvis. They are relieved by the emission of flatus or by stool. This pressure of flatus may incommode the bladder, relief, however, instantly following borborygmi. The urine is foetid and deposits a mucous sediment. Leaving Colocynth for a while we will now compare it with some of its concordant remedies. In the bad effects of anger, Colocynth is closely allied to Chamomilla and Staphisagria and, more remotely, to Causticum. It resembles Chamomilla in the violence of its emotions. Both drugs may be used in children when violent emotions produce cramps and even bilious stools Chamomilla differs from Colocynth in the violence of its con- gestive symptoms, hot sweat on the head, etc. The characteristic Chamomilla temperament also helps you to decide. 268 A CLINICAL MATERIA MEDICA. Staphisagria is sometimes to be substituted for Colocynth in the effects of violent emotion in women and children when the violent abdominal cramps fail to yield to that remedy. In its abdominal and gastro-enteric symptoms you should compare it with Aconite, Veratrum album, Bovista, Croton tiglium, Elaterium, and Mercurius. Veratrum album has abdominal pains forcing the patient to bend double, but he must walk about for relief. He also has cold sweat on the forehead. It is especially suitable in ileus or intussusception of the bowels. The colic of Bovista finds relief from bending double after eating. The urine is red. Croton tiglium has these pains with profuse watery diarrhoea. The stools are yellowish, brownish or green in color and profuse, coining out with a gush as water from the hydrant. They are aggravated after nursing or eating. As shown by the symptoms, Colocynth is a remedy sometimes needed in summer complaint and in dysentery. It differs from Croton tiglium which has stools whenever the patient eats or drinks, in that these movements are profuse and watery, and gushing like water from a hydrant. Elaterium again changes the picture by producing olive- green stools, profuse and gushing. Croton tig., it is true, causes green stools, but they are a brownish green. Colocynth differs from Mer- curius because the tenesmus, etc., cease after stool in the former. It differs from Nux vomica also, for though the pain ceases after stool in Nux, the movements are scanty and there is frequent ineffectual urging. The griping already referred to, is not, in Colocynth, confined to the intestinal tract. We may confidently employ the remedy when the griping involves the bladder in some forms of strangury or of spasm of that viscus, and also in menstrual colic, whether uterine or ovarian. All that is requisite is that the nervous element shall predominate over the inflammatory, with the relief from bending double and from firm external pressure. Transferring this '' nervous action '' of the drug to the '' voluntary system," to the cerebro-spinal system, we find symptoms like the fol- lowing: Left sided tearing crampy pains after vexation or mortified feelings; boring, tearing pains in the head, boring stitches, sharp cut- ting pains in the eyeballs and extending thence up into the head; worse at rest and on stooping, and better from firm pressure and from COLOCYNTHIS CUCUMIS. 269 walking; eye, on stooping, feels as if it would fall out; profuse acrid tears. These symptoms suggest Colocynth as a remedy in gouty and bilious headaches, and also in the intense pains of iritis, ciliary neural- gia and glaucoma. Here we may compare Chamomilla, Cedron, Spigelia and Prunus spinosa. Chamomilla also has left-sided tearing headache from anger, bilious- ness, etc., but it has more red face, hot sweat, etc. Cedron has periodical pains about the eyes; it is usually, however, supra-orbital, and it may be of malarial origin. Spigelia is very similar to Colocynth. The eye feels too large; the pains are stabbing, tearing and radiating; they are aggravated by pres- sure and motion; Colocynth finding relief by walking in a warm room, and on pressure. Primus spinosa has more crushing pain; a feeling as if the parts were pressed asunder. Colocynth has proven useful in hip diseases, especially of the right side; dull stitches during walking, must stand still; followed by heavi- ness and sensibility of the affected parts; crampy pain as though the parts were screwed in a vise; lies on the affected side with the knee drawn up. In studying these symptoms we also see the application of the drug to sciatica; pains extending down the sciatic nerve to the knee or even to the heel, aggravated by any motion. The attacks of pain are followed by numbness of the whole limb and partial paralysis. If the case is of long continuance, the nutrition of the limb is defective. Sometimes the cramps in the leg are so severe that the patient feels as if the whole leg were fastened down by iron bands. The pains are usually worse at night. Ghaphalium is very similar to Colocynth in sciatica. It has intense neuralgic pains along the course of the sciatic nerve, alternating with numbness. In cramps of the muscles you should compare Colocynth, Nux vomica, Veratrum album and Cholos terrapinoe. In rheumatism, Colocynth may be useful, especially for the stiffness of the joints following the acute disease. If, however, there are concretions in the joints, you should think'of Causticum and Guaiacum. Guided by its constrictive qualities, physicians have used Colocynth in paraphimosis. Colocynth is antidoted by Coffee, Camphor and Staphisagria. LECTURE XXVIII. BRYONIA ALBA. i. Blood. 2. Serous Membranes. 3- Muscles. 4- Skin. Bryonia. < a. Rash; Measles. b. Scarlatina. c. Suppressed eruptions 5- Mucous membranes. 6. Organs. There are three species of Bryonia, but so nearly identical are they that Allen has classed them under one heading in his Encyclopaedia. It is one of the oldest remedies in the homoeopathic materia medica, and is one of the best proved. Bryonia alba grows plentifully in Eng- land and on the continent of Europe. The tincture is prepared from the roots. It is a polychrest, suitable to many kinds of disease. To give you all its symptoms, even all its characteristic symptoms, would take two or three hours of steady hard work. I will endeavor in the hour before us to so far explain the action of Bryonia that you may be able to apply the drug and, as I have said before, supply the deficien- cies at leisure. We find Bryonia indicated first of all in changes in the blood; in changes affecting its quantity, its quality and its circulation. For ex- ample, it is indicated in febrile conditions; in fevers of an intermitting type, although not frequently; in those of a remitting type, very often; sometimes, too, in synochal fever; and also in rheumatic, gas- tric, bilious, traumatic and typhoid fevers, in all of which, gastric symptoms are prominent. The symptoms which characterize its fevers are in general these: There is an increased action of the heart, giving rise to a frequent hard tense pulse, very much as you find under Aconite. There is actually an increase in the force and power of the heart's action. This action is augmented by any movement of the body, consequently the patient is anxious to keep perfectly quiet. Then you find that there is almost always intense BRYONIA. 27I headache with these fevers. This is usually of a dull throbbing char- acter or there may be sharp stabbing pains in the head. This is almost always associated with sharp pains in or over the eyes. All of these parts are exquisitely sensitive to the least motion. The patient will avoid moving the eyes, for instance, because it aggravates the pain. The least attempt to raise the head from the pillow causes a feeling of faintness and nausea. The mouth is very dry and the tongue is coated in the milder forms of fever as, for instance, in the synochal fever or in the light gastric type of fever. The coating on the tongue is white, and is especially marked down the middle. The edges of the tongue may be perfectly clean. As the fever grows in intensity, it approaches more a typhoid type. Bilious symptoms predominate. This white tongue becomes yellowish and is associated with a decidedly bitter taste in the mouth. There are splitting headache, tenderness over the epigastrium, with stitches, soreness or tenderness in the right hypochondrium. As the typhoid symptoms increase, the tongue be- comes more and more dry, but still maintains its coating. If the fever is of an intermittent type, you will always find the chill mixed with heat, that is, during the chill the head is hot, the cheeks are a deep red and there is decided thirst, which is generally for large quantities of water at long intervals. In some cases it may be a continuous thirst. The pulse is hard, frequent and tense. The sweat is provoked by the least exertion and has either a sour or an oily odor. In typhoid fever, Bryonia is indicated in the early stages and by the following symptoms: There is some confusion of the mind; the sensorium i's depressed but there are no perversions of the senses. During sleep there is delirium, which is usually of a mild character. On closing his eyes for sleep, he thinks he sees persons who are not present. On opening them, he is surprised to find that he is mistaken. Sometimes this delirium is accompanied or preceded by irritability. This speech is hasty, as you find under Belladonna. As the disease in- creases, some little heaviness almost approaching stupor accompanies sleep. The patient has dreams, which have for their subject the oc- cupation of the day. Frequently with this delirium, the patient suf- fers from an agonizing headache. This is usually frontal. If the patient is able to describe it to you, he will tell you that his head feels as if it would burst. No better term than " splitting headache" could be used to describe it. It is congestive in its character. The face is usually flushed and of a deep red color. This is intensified like all the other symptoms of the drug, by any motion of the head, and is 272 A CLINICAL MATERIA MEDICA. often accompanied by nose-bleed. The epistaxis is particularly liable to come on at three or four o'clock in the morning, and is frequently preceded by a sense of fulness in the head. In very severe cases, you will notice that the patient puts his hand to his head as if there were some pain there, and his face is expressive of pain. Yet so stupid is he, that he makes no complaint other than that expressed by these automatic movements. Another symptom to be noted in these typhoid fevers, is the dryness of the mucous membranes, especially those of the mouth and stomach. This is the result of deficient secretion. In no case is the condition more apparent than in typhoid states. The mouth is dry, as I have already intimated, and yet there may be no thirst. If there is thirst it seems to have the character I mentioned in speak- ing of intermittent fever. The patient drinks large quantities but not very frequently. After drinking water or while attempting to sit up, the patient has a deathly nauseated feeling and sometimes even vomits. At other times he complains of a heavy pressure in the stomach, as if a stone were lying there. This symptom is no doubt due to the same pathological condition we found in the mucous membrane of the mouth. The secretion of gastric juice is deficient, consequently food lies un- digested in the stomach. The bowels are usually constipated when Bryonia is called for. When they do move, the stools are large, hard and dry and either brown or black in color. They are expelled with difficulty owing to the atony of the rectum. Sometimes, in well- advanced cases of typhoid fever, you will find soft, mushy stools, calling for Bryonia. There is a symptom which sometimes accompa- nies typhoid fever at about the end of the first week of the fully de- veloped fever, and that is a form of delirium in which the patient expresses a continual "desire to go home." He imagines that he is not at home and longs to be taken there in order to be properly cared for. This symptom is a strong indication for Bryonia and frequently disappears after two or three doses of the remedy. In these febrile conditions, it is necessary to place Bryonia in its proper relations with its concordant remedies. First of all Aconite. Aconite bears an intimate relation with Bryonia in all these types of fever except gastric, intermittent and typhoid fevers. Aconite has not in its totality any special relation to any of these, however incor- rectly it may be given to lessen the temperature. The symptomatology of Aconite is opposed in every respect to that of typhoid fever. In gastric fever, it may be given in the beginning when there is the full pulse, hot and dry skin and restlessness, indicating that drug; but as BRYONIA. 273 the fever advances, it is then not indicated unless there are bilious com- plications. Then it is an all sufficient remedy. The distinctions that you are to make between Aconite and Bryonia are as follows: In the first place, they hold the relation of Aconite and Bryonia and not Bryonia and Aconite; that is to say, Aconite is given earlier in the case than is Bryonia. Aconite suits the hyperaemia, the congestion or even the chill which precedes an inflammatory fever. Bryonia is in- dicated later when Aconite fails. The mental symptoms of the two drugs are so distinct that you ought not to confuse them. Aconite demands that the mind be excited, that the patient be restless, tossing about the bed, full of fears. He imagines that he is going to die. The Bryonia patient may suffer just as much as the one to whom you would give Aconite, but he is perfectly quiet. He is quiet because motion aggravates his symptoms. Early in typhoid fever, and sometimes in rheumatic, you may have Bryonia indicated by this symptom: The patient is restless and tosses about the bed impelled by nervousness, and yet he is made worse by the motion. Still another remedy to be thought of in connection with Bryonia in these fevers is Belladonna, and particularly in the beginning of typhoid fever. Now there is really nothing in the symptomatology of Bella- donna which would call for it in a well-advanced case of typhoid type of fever. Only in the beginning could you confuse it with Bryonia. In the first place it has erethism. Here you distinguish it by its de- lirium, which is of a violent character. The patient jerks his limbs and starts during sleep. He springs up from sleep in affright. As soon as he closes his eyes, he sees all sorts of objects and people, which disappear as soon as the eyes are opened. Belladonna, then, has more cerebral erethism, and more violence in its delirium than has Bryonia. With the Belladonna headache there are throbbing pains, and the patient may be obliged to sit up rather than keep perfectly quiet in order to obtain relief. Another remedy to be compared with Bryonia is Rhus tox. This is often indicated in typhoid fever. You all know the historic fact that Hahnemann during one of the war epidemics of typhus cured many cases with these two remedies. Since the days of Hahnemann, this use of these remedies has become universal. Remember, how- ever, that they are not specifics. Each epidemic may so change in character as to require other remedies. Rhus tox. is indicated, when there is marked restlessness. The patient first lying on one side, changes to the other. For a few moments, he feels better in his new 18 274 A CLINICAL MATERIA MEDICA. position. Then his side begins to ache and back he turns again. Like Bryonia, it has nose-bleed, which nose-bleed relieves the patient's symptoms, and the headache I described to you last month as " a sen- sation as though a board were strapped tightly across the forehead." There are rheumatic aching pains through the joints and muscles of the limbs. The tongue differs from that of Bryonia. It is brown and dry and even cracked, and has a red tip. That is also an excellent indication for Sulphur. With Rhus tox., there is frequently diarrhoea from the very beginning. Bryonia usually has constipation. I just referred to the symptom under Belladonna—" The patient sees persons and objects on closing the eyes; these disappear as soon as the eyes are opened." Both Calcarea ostrearum and Cinchona have this symptom. Under the latter remedy, however, it does not occur in typhoid fever, but after haemorrhage. Next, I wish to talk about the action of Bryonia on serous mem- branes. Bryonia acts powerfully on these, producing inflammation. Hence we are called upon to prescribe it when the meninges of the brain and spinal cord, the pleura and the peritoneum, and the synovial membranes are inflamed. The indications for Bryonia in these serous inflammations are particularly to be looked for after exudation has taken place. There are sharp stitching pains, worse from any motion. The fever may still be high or it may have been partially subdued by the remedy which preceded. Comparing Aconite with Bryonia once more, you will see the same rule applicable here as before; Bryonia is indicated after and not be- fore Aconite. Take for purpose of illustration a typical case of pleu- risy. In the beginning of the disease when fever is high you select Aconite, but just so soon as the fever commences to decrease, and as effusion begins, as indicated by the friction sounds, Aconite ceases to be of any benefit and Bryonia comes in as an all sufficient remedy. It is customary with some physicians to give Aconite for the fever and Bryonia for the pleuritic trouble. But this is useless. Bryonia is adapted to the whole case. It has not the same restlessness which demands Aconite. The patient is quiet and is full of pain. He lies on the affected side. Why? Because by the pressure thus exerted on the ribs, he moves the affected parts less than he would were he lying on the sound side. When the meninges of the brain are affected, Bryonia is a valuable drug, but here, except in some rare cases, it follows Belladonna rather than Aconite. Belladonna ceases to be the remedy in meningitis, BRYONIA. 275 whether tubercular or otherwise, when effusion within the ventricles or beneath the membranes commences. It then gives place to Sulphur in some cases, Apis in others, and Bryonia in still others. Bryonia is in- dicated when meningitis follows the suppression of some eruption, as that of scarlatina or measles. The child's face is pale, or else it is red and pale alternately, the tongue white. The child screams out sud- denly as if it was in great pain, which it really is. These pains are of a sharp lancinating character and are especially manifested on mov- ing the patient. There is marked squinting with one or both eyes. The bowels are usually constipated, the abdomen distended and the child has well-marked sensorial depression which seems to border on stupor. If you arouse the child and offer him drink, he takes it im- petuously or hastily, just as under Belladonna. The latter remedy has more rolling of the head. For sake of convenience we will next study the catarrhs of Bryonia and the effects of the drug on the lung structure. We find Bryonia indicated in nasal catarrh when there is either great dryness of the mucous membrane of the nose or (more frequently), when the discharge is thick and yellow. It is also indicated when the discharge has been of the character just indicated and has been suddenly suppressed. As a result, there is dull throbbing headache just over the frontal sinuses. Lachesis is also useful for suppressed coryza. But it has not so marked an aggravation from motion; nor has it that yellow discharge. The treatment of colds is a severe test of the skill of a physician. If you can successfully treat them, you must understand homoeopathy well. They are the most difficult class of cases we have to contend with. There are two reasons for this. One is the patients are constantly ex- posed, and the other is that they are not watched sufficiently closely. If you are given the opportunity to watch the cases carefully, so that you may prescribe as the indications change, you will cure promptly. We may also use Bryonia in pneumonia. The type of the disease in which it is indicated is in the true croupous form. Just as we found Bryonia indicated in pleurisy with effusion, so is it of use in pneumonia after the croupous exudation has taken place. Usually when it is called for there is also some pleuritis, hence it is applicable to pleuro- pneumonia. It is not indicated in the beginning of the disease because the exudation does not occur in that stage. It is indicated after Aconite, with the following easily understood condition. The fever still con- tinues, but the skin is not so hot, the face so red and the patient so restless as when Aconite was indicated. The patient is more pacific, 276 A CLINICAL MATERIA MEDICA. and his face and whole demeanor are expressive of anxiety. I would have you discriminate between this condition and that calling for Aconite. It is not so much the mental anxiety that Aconite pictures as it is an expression of pulmonary oppression. That you must remem- ber. The cough which under Aconite was of a dry teasing character, with frothy sputa, perhaps still remains troublesome, but it is looser and more moist. There is very little expectoration yet, but what little there is, is either yellowish or streaked with blood. Owing to the ac- companying inflammation of the pleura, sharp pleuritic stitches are felt in the. chest. They are worse on the left side. The patient com- plains of heavy pressure just over the sternum. The pulse is full, hard and tense. The urine is dark-red and scanty. Still another remedy that ought to be thought of along with Bry- onia in pneumonia is Antimonium tartaricum. It is indicated in pneu- monia that begins as a bronchitis and extends downwards. It is especially suited to cases that begin on the right side, and that have these sharp stitching pains, high fever, great oppression of the chest, as in Bryonia. But it is called for more in catarrhal than in croupous pneumonia. Mucous rales are heard distinctly in the chest. You should also recall Sanguinaria and Chelidonium. Several other remedies than Bryonia have these pains in the chest- walls. Gaultheria has pleurodynia, with pain in the anterior medias- tinum. Ranunculus bulbosus is decidedly the best remedy for intercostal rheumatism; it has sharp, stitching pains, and a sore spot in the chest, and these are worse from any motion (even breathing), pressure, or change of temperature. The dyspnoea in these cases is sometimes dis- tressing. Arnica is sometimes of use when the sore and bruised feeling of the chest predominates. Rhus radicans is called for in pleurodynia when the pains shoot into the shoulder. Senega acts best in fat persons of lax fibre. It is useful in cold when there are much pain and soreness in the thoracic walls, and much mucus within. There is hoarseness; the throat is so dry and sensi- tive that it hurts the patient to talk; the cough often ends with sneez- ing- Rumex crispus has sharp, stitching or stinging pains through the left lung; it is indicated more in the early stages of phthisis. When the patient turns the left side feels sore. BRYONIA. 277 Trifolium pratense has hoarseness aud choking spells at night with the cough. The neck is stiff; there are cramps in the sterno-cleido- mastoid muscles which are relieved by heat and friction. Actea racemosa has pleurodynia; worse in the right side, especially in nervous women. In bronchitis, Bryonia is indicated with this same pressure over the sternum; the dyspnoea is great; the cough is dry, and seems to start from the stomach. Sometimes a little tenacious blood-streaked sputum is raised. The cough is worse after a meal, when it may even end in vomiting. During the cough the patient presses his hand against his side to relieve the stitching pain. Returning now7 to the action of Bryonia on the serous membranes, we find it producing synovitis. The affected joint is pale-red and tense. There is, of course, effusion into the synovial sac. There are sharp, stitching pains, aggravated by any motion. Bryonia is indi- cated in these cases whether the synovitis be of rheumatic or traumatic origin. The nearest concordant remedy to Bryonia here is Apis, which is an excellent remedy for synovitis, particularly of the knee-joint. Sharp, lancinating, and stinging pains, and effusions into the joint, are fur- ther indications for the remedy. Apis seems to be preferable to Bry- onia when this synovitis is of scrofulous origin, or at least appears in a scrofulous constitution. Apis also has another kind of inflamma- tion, which ends in thickening of the serous sac and of the tissues and cartilages about the joints, giving you the well-known white swelling. You should also remember Sulphur in these cases. This remedy supplements Bryonia and Apis, and urges them on when they fail to do their work. We come next to the study of Bryonia in its action on the muscular system. It is one of the few drugs which produce a positive inflam- mation of the muscular substance; consequently, you expect to find the drug of use in muscular rheumatism. The muscles are sore to the touch, and at times swollen, and, as you might expect, there is aggra- vation of the pains from the slightest motion. Bryonia may also be indicated in -articular rheumatism. We find that the fever is not very violent, and the pains and swelling either shift not at all or else very slowly. The local inflammation is vio- lent; that is characteristic of Bryonia. The parts are very hot, and dark- or pale-red. The pulse in these cases is full and strong, and the 278 A CLINICAL MATERIA MEDICA. tongue is either uniformly white or, more characteristically, dry and white down the centre. The bowels are constipated. It is needless for me to say that the pains are worse from motion. The difference between Bryonia and Rhus is principally this: Rhus is suitable for rheumatism after exposure to wet, especially when one is overheated and perspiring. Then, too, the Rhus patient finds relief from moving about. Rhus attacks the fibrous tissues, the sheaths of the muscles, Bryonia the muscular tissue itself. The difference between Ledum and Bryonia may be described in this way: Ledum is useful for rheumatic or gouty inflammation of the great toe; instead of tending to copious effusion the effusion is scanty, and tends to harden into nodosities. In hot swelling of the hip and shoulder joints, Ledum should be remembered as more successful than Bryonia. Actea spicata has a special affinity for the smaller joints. It has this characteristic: The patient goes out feeling tolerably comfortable, but as he walks the joints ache and even swell. Viola odorata has a specific action on the right wrist. Caulophyllum is especially suited to rheumatism of the phalangeal and metacarpal joints, particularly in females. In Colchicum we have marked aggravation in the evening; the affected joints are swollen and dark red. It is especially useful for weak debilitated persons, or in those who despite local rheumatic in- flammation, exhibit general symptoms of torpor. The stomach is generally affected; nausea when smelling food. The urine is scanty and red, and burns in passing along the urethra. The pains are of a tearing or jerking character, and appear as if in the periosteum. The pains are superficial in summer and deep in winter. In metastasis of rheumatism to the heart, both remedies are to be studied. Bryonia has great oppression under the sternum, worse from motion; sharp stitches in the cardiac region, pericardial effusion, with strong pulse. Colchicum has pericardial effusion, fulness and oppression while lying on the left side, compelling him to turn over. The pulse is small, weak, and accelerated. The Colchicum pains appear about the neck and shoulders, or, in a small part of the body at a time, and then shift quickly. Guaiacum is useful in chronic forms of rheumatism when the joints have become distorted by the concretions. It is also indicated in pleu- risy during the second stage of phthisis with muco-purulent sputum. Arctium lappa may also be compared with Bryonia in rheumatism. It cures soreness of the muscles, dull pains, all worse from motion; BRYONIA. 279 high-colored urine. All the provers were so weary and sleepy, they could not work. Next we will study the alimentary canal. We have already spoken of Bryonia here so frequently that its symptoms require but a passing notice. There are the dryness of the mucous lining throughout; the white coating of the tongue, the characteristic thirst, a feeling as though a stone or heavy weight were lying clogged in the stomach, the hard dry, brown stool, passed with difficulty owing to the hardness of the faecal matter, atony of the rectum, and intolerance of vegetable food. The symptoms are all worse in summer. It seems that the Bryonia patient cannot tolerate the heat of the sun. The liver also is affected. We find it congested, or even inflamed. The gastric symptoms just mentioned complicate the case. The peritoneum covering the liver is inflamed, consequently there are sharp stitches in the right hypochon- drium, worse from any motion and better when lying on the right side. In jaundice from duodenal catarrh, you may give Bryonia, especially when the trouble has been brought on by a fit of anger. Although the patient appears hot, he complains of feeling chilly. Chelidonium is an admirable remedy for very similar symptoms to Bryonia ; sharp pains in the region of the liver, shooting in every direc- tion, up into the chest, down into the abdomen; well-marked pain under the scapula, even going through the chest like a rivet; and diar- rhoea with either clay-colored or yellowish stools. It differs from Bryonia particularly in the character of the stool. Bryonia is also similar to Kali carb., which is indicated in bilious affections when there are these sharp pains in the right hypochondrium, shooting up into the chest; often there is sharp pain, coming from the lower lobe of the right lung. The difference between these pains and those of Bryonia is that these are not necessarily made worse by motion. Yucca filamentosa is an admirable remedy for biliousness, with pain going through the upper portion of the liver to the back. There is bad taste in the mouth; the stools are diarrhoeic and contain an excess of bile. A great deal of flatus passes by the rectum. Chamomilla, like Bryonia, is indicated in biliousness following anger. With Bryonia there is apt to be chilliness with the anger; with Cham- omilla the patient gets hot and sweats. Berberis vulgaris also has sharp stitching pains in the region of the liver; but the pains shoot downwards from the tenth rib to the um- bilicus. The bowels, I have said, are usually constipated under Bryonia, but 28o A CLINICAL MATERIA MEDICA. in some cases the reverse condition obtains. Bryonia is indicated in diarrhoea when the attacks are provoked by indulgence in vegetable foods or stewed fruits, and also by getting overheated in the summer time. The movements are especially worse in the morning after rising when beginning to move around, thus distinguishing it from Sulphur and making it akin to Natrum sulph. In other cases, the patient is seized with sudden griping pains, doubling him up, with copious pasty stools. Sometimes the stools are dark green, from admixture of bile. They have the odor of old cheese. The mental symptoms of Bryonia have been pretty thoroughly described to you in speaking of typhoid fever. I will merely say here that the patients are irritable and easily angered. This is present with the bilious symptoms, with the headache; and with the dyspepsia; in fact, it is characteristic of the remedy. The headache of Bryonia, I have also told you, is worse from any motion; even a movement of the eyeballs aggravates the pain. The pain begins in the occiput, or else in the forehead going back into the occiput. It is worse when awaking in the morning, and after violent fits of anger. The nearest remedy that we have to Bryonia here is Gelsemium, which has headache with this soreness of the eyes on moving them. Natrum mur. has headache, with beating as from little hammers, with aggravation on moving the head and eyes. With the occipital headache of Bryonia we should also compare Petroleum, which has throbbing occipital headache; and fuglans cathartica for occipital headache with pains of a sharp character. Carbo veg. and Nux vomica have occipital pains with bilious attacks. On the external head, we find Bryonia developing an oily perspira- tion with a sour odor. A similar symptom referred to the face is found under Natrum mur. Bryonia is a valuable remedy in disease of the eyes, not when the external coats of the eyes are affected, however. It is to be thought of for metastasis of rheumatism to the eyes. The pains are violent and shoot through the eyeball into the back of the head, or up toward the vertex. It is aggravated by any motion of the head or eyes. There is also a sensation of tension as if the eyeballs had been put on a stretch. Now you know, from what I have said, that Bryonia is BRYONIA. 28l indicated in inflammation of the serous membranes with effusion. Bryonia ought, both symptomatically and pathologically, to be a remedy in glaucoma. The tension of the eyeball is greatly increased. Hot tears flow from the eyes. Photophobia and diminution of vision are present. The toothache of Bryonia is of a rheumatic origin and comes from cold. You will frequently find it in teeth showing no signs of decay. We are therefore led to presume that it is the nerve that is affected. More than one tooth may be involved and relief is momentarily ob- tained by firm pressure of the head against the pillow, or by the appli- cation of cold. Toothache in children from decayed teeth, with relief from the application of cold water finds its best remedy in Coffea. Kreosote has neuralgia of the face with burning pains increased by motion and by talking, especially in nervous, irritable persons whose teeth decay rapidly. In aphthous sore mouth, Bryonia may be used. The child seizes the nipple, but drops it and cries, but—notice the characteristic dry- ness—when its mouth becomes moistened by the milk it nurses well enough. The characteristic urine of Bryonia is dark, almost brown red, with- out any deposit. The changes in its appearance are due to excess of coloring matters. Bryonia has some action on the female genital organs. It is indi- cated in menstrual difficulties when the flow is dark red and profuse, but more especially when it has been suppressed and we have what has been termed vicarious menstruation. Here you should compare Pulsatilla and Phosphorus, especially if the suppression of the flow produces haemoptysis or haematemesis. Senecio if the patient has cough with bloody expectoration. Hamamelis, Ustilago and Millefolium for haematemesis. Bryonia is indicated in the lying-in chamber. For years I have been accustomed to using Bryonia for the so-called milk fever. I consider it indicated more than any one remedy because the symptoms are those of Bryonia. There is not very marked fever, there is this tension of the breast with headache, tearing in the limbs and the patient is weary and wants to keep still. In threatening mammary abscess, Bryonia is indicated when there are sharp stitching pains, tension of the breast, and pale red color to the swelling. 282 A CLINICAL MATERIA MEDICA. In incipient mammary abscess you should compare first of all Bella- donna, which is useful when the symptoms are violent; redness shoots out in radii from the central point of the inflammation. Phytolacca is an excellent remedy when from the beginning the breasts show a tendency to cake. Especially is Phytolacca the remedy when suppuration threatens. When the child nurses, pain goes from the nipple all over the body, streaking up and down the spine; exces- sive flow of milk. Phellandrium aquaticum is an excellent remedy when pains course along the milk ducts between the acts of nursing. Croton tiglium, when there is pain from the nipple through to the back when the child nurses, as though it were being pulled by a string. Bryonia is to be remembered in measles. Here it is indicated prin- cipally by the tardy appearance of the rash. There is a hard, dry cough which makes the child cry. The child doubles up as if to resist the tearing pain which the effort at coughing causes. There may be little or no expectoration. The eyes are inflamed. In other cases the erup- tion suddenly disappears and cerebral symptoms appear. The child is drowsy. Its face is pale and there is twitching of the muscles of the face, eyes and mouth. Any motion causes the child to scream with pain. In other cases instead of these cerebral symptoms you have inflammatory diseases of the chest, bronchitis or even pneumonia. In scarlatina, Bryonia is not often indicated, but when it is, you find some one or all of these symptoms to guide you. The rash has not that smooth character observed under Belladonna. It is interspersed with a miliary rash. The eruption comes out imperfectly and the chest and cerebral symptoms just mentioned are present. Now while all the senses are benumbed in these cases there are no absolute hallucinations of the senses as under Belladonna, the patients do not hear voices talk- ing to them as under Anacardium; they do not awaken from sleep clinging to those about them, as with Stramonium or Cuprum. When an eruption has been suppressed and the brain affected in con- sequence, you may also look to Cuprum, which is the remedy when the symptoms are violent. The child starts up during sleep. There are decided perversion of the senses, and the spasms characteristic of Cuprum. Zincum is to be preferred if the child is too weak to develop an eruption. The eruption comes out sparingly. The surface of the body is rather cool. The child lies in a stupor, grating its teeth; it starts up during sleep. Squinting and rolling of the eyes are observed and there is marked fidgetiness of the feet. BRYONIA. 283 Ipecac, is to be thought of when the chest is affected from the reces- sion of the rash of measles, when there is difficulty in breathing, cough, etc. Tartar emetic ought to be given in preference to Bryonia when the disease is variola. Bryonia is complementary to Alumina. It is antidoted by Chamomilla, Nux vomica, Pulsatilla, Rhus and Senega. It antidotes Rhus tox., Rhus venenata and Chlorine. LECTURE XXIX. CONIFERS AND EUPHORBIACE^. Coniferae. Abies Nigra.—Stomach. Sabina Juniperus.—Abortion. Pinus Sylvestris.—Infantile atrophy. ' Kidneys, bladder, etc. Mucous membranes. Terebinthina. < Uterus. Typhoid states. Renal dropsy. Compare Arsenicum, Cantharis, Copaiva, Camphor, Phosphorus Pix Liquida.—Lung; Eruptions. Compare Anisum stellatum. Nervous system. Sycosis. Syphilis. Variola. Marasmus. Thuja. Compare Pulsatilla, Kali bichromicum, Spigelia, Mercurius, Nitric acid, Natrum sulph., Euphrasia, Staphisagria. The large order of Coniferae or cone-bearing plants is the subject for our study to-day. From this order we obtain the different varieties of pine, hemlock, and spruce from which the different preparations of turpentine have been obtained. The principal remedies of this group you will see in the schedule on the board. They are the Abies nigra, or black spruce; the Sabina juniperus, one form of the juniper from which the oil of savin, a well-known remedy for the production of abortion, has been taken; the Pinus sylvestris, a variety of the pine; ABIES NIGRA, SABINA, AND TEREBINTHINA. 285 Terebinthina, or turpentine, obtained from many of the pines; Pix liquida, or pitch; and Thuja occidentalis, the arbor vitae or the tree of life. « Abies Nigra. I cannot forbear mentioning a symptom of this Abies nigra, a symptom, too, that has been frequently confirmed. I refer to the application of the drug in dyspepsia when the patient complains of a feeling as though he had swallowed some indigestible substance which had stuck at the cardiac extremity of the stomach. That is the main symptom and the keynote of the drug. There are also present the low-spiritedness, the hypochondriasis, and the constipation incident to dyspepsia. Sabina Juniperus. I am also obliged to slight Sabina juniperus for want of time. You know of it as a remedy in the treatment of uterine disease, and as a remedy to prevent impending abortion, especially at the third month. The symptoms indicating it here you will learn from the Professor of Gynaecology, Dr. Betts. I shall only say in brief that they are: Pain which commences in the small of the back and goes around and through the pubes, drawing-aching pains which are so common in abortion, and pains which run through from sacrum to pubis. This last symptom is very characteristic of Sabina. In addition to these pains there is a bright red clotted flow of blood, increasing with every motion. You may7 also use Sabina in post-partum haemorrhage when the placenta is retained and the symptoms just mentioned are present. Terebinthina. Terebinthina, or turpentine, is a drug that has been much abused by old-school physicians; therefore it has been greatly neglected by hom- oeopaths. In the revulsion from the misconception of the old-school physicians, we often avoid a drug altogether. All that I have time to say concerning Terebinthina is, that its main action is on the kidneys and bladder. When you find metritis, peritonitis, typhoid fever or scarlatina, or, in fact, any serious disease of low type, with the follow- ing renal symptoms, Terebinthina comes in as your remedy: Dull pains in the region of the kidneys, burning in the kidneys, pains ex- tending from the kidneys down through the ureters, burning during micturition, strangury, albuminous urine, and very characteristically 286 A CLINICAL MATERIA MEDICA. the urine is dark, cloudy and smoky-looking, as though it contained decomposed blood, which it really does. The real pathological con- dition of the kidneys in this case is not one of acute Bright's disease, nor one of croupous formation in the kidneys, but one of renal con- gestion, with oozing of blood into the pelvis of the kidney. When the above urinary symptoms are present, you may give Terebinthina with confidence, no matter what the patient's disease may be. Terebinthina often acts powerfully on mucous membranes. It pro- duces burning in the air-passages, with thin expectoration, very difficult of detachment. Pix Liquida. Pix liquida has but two symptoms worthy of note. One proceeds from its action on the lungs. You may give it with confidence in suppurative processes affecting the left lung, with pain at the third left costal cartilage. Anisum stellatum has the same pain, but here it is referred to the right third costal cartilage. The above symptoms of Pix and Anisum have stood the test of experience over and over again. Remedies having pains in the left side of the chest, and which are here worthy of mention, are: Myrtus communis (upper part), Sumbul (many pains), Fluoric acid, Oxalic acid, Actea rac. (under nipple), Lilium (through the heart or through the mamma to the back), Kali carb., Sulphur (through to back), Sarsaparilla (from back through to left chest), Pulsatilla nuttal. (left side, underarm near to the back), Guaiacum (stitches at about upper three ribs, purulent sputum), The- ridion, Phosphorus and Silicea. Pix liquida also causes an eruption, especially on the dorsum of the hands; cracks, itches intolerably at night, and bleeds when scratched. Thuja Occidentalis. The remainder of the hour we will devote to Thuja occidentalis, the last member of this group, and we will have ample time to consider it fully. The history of the introduction of this drug is a little novel. Hahnemann received in his office on one occasion a patient who com- plained of some symptoms about the genital organs, which were, to say the least, suspicious. There was a thick purulent discharge from the urethra, with burning on urinating. There were also small pimples, attended with itching, about the glans penis, and some swelling of the parts. Hahnemann charged his patient with having contracted gonor- THUJA. 287 rhcea. This was stoutly denied by the patient, who, by the way, was a theological student. However, on the principle prevailing in every court to consider a man innocent until he has been proved guilty, Hahnemann determined to give the young man no medicine, and directed him to report in three days. At the end of that time he came back well. Hahnemann was puzzled. He questioned the patient closely, but found no cause. The young gentleman remembered, how- ever, that as he sauntered through a garden a few days before, he picked some leaves of the arbor vitae and chewed them. This led Hahnemann to investigate the properties of Thuja, when he discovered that the theological student had told the truth. However, Thuja must not be immolated in sycosis, because it has other interesting actions on the system, especially upon the nervous system. While you must remember that these nervous phenomena may rest on a sycotic basis, you should also know that they may exist without the presence of any such taint. Grauvogl tells us of the hydrogenoid constitution in which the poison of gonorrhoea acts most virulently. If one with this constitution contracts the disease, he is more apt to retain the constitutional taint. This constitution may even exist independent of a sycotic taint. In its victims vaccination is most injurious. When you find a patient suffering from vaccination, the virus being pure, you may set that patient down as belonging to the hydrogenoid constitution. We have two antidotes to these bad effects of vaccination, Silicea, which suits almost any of the symptoms, even convulsions, and Thuja, especially if diarrhoea results and the vaccine pustules are very large. It was on account of this last-named symptom that Boenninghausen recommended Thuja in variola. He gave it just as soon as the vesicles began to turn into pustules, and he claimed to have thereby prevented scarring. But to return to a study of the action of Thuja on the nervous system. The patient exhibits a manner which is hurried and impa- tient. He talks hurriedly. His movements are unnaturally active and hurried. His temper is easily aroused. Even trifles make him angry and excited. Some of the gentler emotions are awakened. For instance, music causes weeping and trembling of the feet. There is a form of insanity or mania in which you will find Thuja the only remedy, and that is one in which there is the fixed idea in the patient's mind, that he is made of some brittle substance, and he will not permit himself to be approached Tor fear that he will be broken. This is not the Antimonium crudum condition. It is not an irritability of mind 288 A CLINICAL MATERIA MEDICA. that drives any one and every one away, w7ill not permit one's self to be even looked at, but it is a symptom that comes from some fixed delusion as to his bodily composition. Another singular characteristic of Thuja is one that was first met with in an old maid. She experienced a sensation as though a living child were in the abdomen. This symptom has suggested the use of Thuja in pseudo-cyesis. With these symptoms of the nervous system indicating the drug in melancholia, and other forms of insanity, we find that there are many disturbances in the circulation, ebullition of blood, pulsations all over the body, praecordial anxiety. Still further as illustrating the action of this drug on the nervous system, we find various forms of neuralgia occurring. Thus it is indicated in the form of headache known as clavus, in which the patient has a sensation as though a nail were being driven into the vertex, or into one or the other of the frontal eminences. Thuja may also be used in neuralgia, affecting either head or face or both. The pains are of an intense stabbing character, and are well-nigh unbearable. If the patient sits up these pains almost drive him to distraction; they may even produce unconsciousness. He, therefore, maintains the horizontal posture. The pains seem to begin about the face, about the malar bones and eyes, and go back towards the head. It is a neuralgia which reminds us of Spigelia, but which we distin- guish from that of the last-named remedy by the direction of the symptoms. In Spigelia the pains begin in the back of the head and come forward. After detailing to you these unique nervous symptoms, I pass to state the application of the drug to sycosis. Remember that these nervous phenomena may or may not have a sycotic basis. Thuja is a remedy which tends to alter the sycotic constitution, to change the soil on which this poison grows. There are two elements which make up disease; they are the elements of the disease itself, and those of the constitution in which it grows. The sycotic constitution to which I have referred, modifies every subsequent disease, and that, too, whether there be any urethral discharge or not. In gonorrhoea you may use Thuja when the discharge is thin and greenish, and there is scalding pain during urination. After urina- tion there is a sensation as if there were a drop of urine remaining behind. Warts or condylomata appear on the genitals, at the anus, about the perineum and upon mucous surfaces. I have treated one case in which the wart formed on the centre of the tongue. This was THUJA. 289 speedily cured by Thuja. These warts may have a seedy look, or they may be of a cauliflower shape. Cauliflower-like excrescences are especially apt to grow from the cervix uteri. In other cases, these warts are moist and ooze a glutinous fluid. Sometimes we find ulcers about the genitals, and these bear very much the appearance of chan- croids. They have a dirty yellow base with hard edges. Very char- acteristic are such ulcers if they seem to have originated from warts. Sometimes we note deep fissures, or furrows about the anus, on the perineum, scrotum or glans penis. These are quite deep and are covered with pus. There is sweet smelling sweat about the genital organs. The inner sides of the thighs are red and excoriated. The testicles are often involved, one or the other of these organs being drawn up in consequence of contraction of the cremaster muscle. The testicle is swollen and aches as if bruised. There may be balanorrhoea, that is purulent inflammation of the inner surface of the prepuce, and of the sulcus back of the corona glandis. In the female organs we find the cauliflower excrescences which I have already mentioned, fungus growths of venereal origin about the genitals, condylomata with thick green leucorrhcea, corresponding to the thin greenish-yellow gleet of the male. Again, if a gonorrhoea be checked by injection, by cold or by any other influence, constitutional symptoms may arise which call for Thuja. Especially is this remedy indicated if the complication be articular rheumatism, or prostatitis. The hair becomes dry and splits at the ends, the scalp scaly and covered with dry scurf. Thuja is even the remedy when iritis appears, especially when ac- companied by condylomata on the iris. The eyelids are inflamed and have a warty look also. Ozaena may be an additional complication. When Thuja is indicated the discharge is thick and green. A very common symptom indicative of a sycotic taint, for which you may use Thuja, is decay at the root of the teeth, the crowns of the teeth being apparently normal. Other symptoms worthy of mention are pustules, which have considerable resemblance to those of Tartar emetic, and chilliness during urination, nervousness and restlessness during both night and day. There is further a singular property of Thuja, that of softening hard tissue, tissue naturally hard, as the nails. Herein lies the explanation of the ability of the drug to remove warts; it softens them and causes their absorption. Thuja has a specific action in sclerotitis. 19 290 A CLINICAL MATERIA MEDICA. Thuja is also a remedy in scrofula and marasmus. Such cases are not necessarily sycotic, but they have just such constitutions as favor the growth of this taint. The stools are watery, gurgling, forcibly expelled, and are daily worse after breakfast, and accompanied by much loud flatus; tinea ciliaris, dry braulike scales; eyelashes irregular and imperfect; children are pot-bellied; scream on awaking, and are a long time becoming fully awake. I propose now to devote the remaining moments of the hour to the consideration of the remedies similar to Thuja in the above mentioned conditions. One of the nearest allies to Thuja is Pulsatilla, in that it has ozaena with thick greenish discharge. In gleet, also, the remedies have the same discharge, it being thicker under Pulsatilla. Then, too, gonorrhoeal rheumatism, orchitis and prostatitis, are just as character- istic of Pulsatilla as of Thuja. Kali bichromicum is useful in ozaena occurring in sycotic constitu- tions, the discharge being yellowish or more often greenish. The nose feels unnaturally dry. Dark greenish plugs are hawked down from the post-nasal space. Nitric acid resembles Thuja in the condylomata or warts. It is also of use in ulcers, when they are ragged in outline, and in enlarged tonsils, whether these affections be of syphilitic or of gonorrhoeal origin. Nitric acid also has moist fissure at the anus (which is also present, as you know, under Thuja), balanorrhoea and thin greenish leucorrhcea. Nitric acid has, however, to distinguish it from Thuja, more aching pains in the bones, especially in those localities devoid of muscular-tissue cov- ering, as along the tibia, and over the sternum and cranium. Staphisagria suits long filiform condylomata. The system generally is depraved, as shown in the sallowness of the face, the dark rings about the eyes, the spongy gums, the yellowish white skin, and the great debility. It is especially indicated when there has been previous mercurialization. There is generally induration of one or the other testicle. I would like to mention here facaranda. This is a South American plant that was first proved by Muir. It is an excellent remedy for balanorrhoea, and for red chancroid or chancroid-like sores about the penis. It has been proved conclusively to be a good remedy. Corallium rubrum is an excellent remedy for chancre-like sores that are very red. Mercurius resembles Thuja in the iritis, in the balanorrhoea, and in the green urethral discharge and in the rheumatism. The difference EUPHORBIACEAE. 29I lies here: In Mercurius, sweating aggravates the symptoms, as does also the warmth of the bed. Thuja has this symptom which is not often met with, but which saved a life for Bcenninghausen, namely, uncovered parts of the body only sweat. Sabina is useful for condylomata which itch and burn, especially in women. Euphrasia is called for when the condylomata are large and look like a cock's comb. Cinnabaris is an excellent remedy when there is a combination of syphilis and sycosis. The figwarts are apt to be fan-shaped. There is a great deal of itching, especially about the joints. The complement of Thuja in these sycotic troubles is Natrum sulph. Sarsaparilla is indicated when a sycotic eruption consisting of little spots scarcely raised above the skin, often scaling a little, but looking like the roseola of syphilis, and itching intolerably, and worse in the spring; also when a moist eruption appears on the scalp, the pus from which causes inflammation of any7 part which it touches. Sycotic headache is found under Sarsaparilla. The pain begins in the back of the head, and comes forward and settles at the root of the nose, with swelling of the nose; moist eruption about the genitals, or between the scrotum and the thighs. Petroleum also has this last-named symptom; and in addition another, namely, membranous shreds about the anus. Euphorbiaceae. The Euphorbiacece as an order contain an acrid principle which in some cases is oily in character, in others resinous; in case it is the latter, it escapes from the plant as a milky juice drying into a gum. These oils or gums have two properties. If applied to the skin they produce redness and vesication. The vesicles fill with yellowish-white serum, and may even suppurate and form scabs of a honey color. They all act more or less intensely as purgatives, producing a watery diarrhoea, associated with colic, tenesmus, flatulence, burning, nausea and vomiting. The medicines we derive from this order are the Cro- ton tiglium, Jatropha curcas, Yucca filamentosa, Euphorbium officinarum, Euphorbia corollata, Mercurialis perennis, Hippomane mancinella and Ricinus communis. Croton tiglium produces a diarrhoea with yellowish watery stool pouring out like water from a hydrant, often associated with nausea and vomiting. This nausea is of a very aggravating character, and is 292 A CLINICAL MATERIA MEDICA. attended by faintness and loss of sight. Colic appears and is better from warm drinks. The stool returns with any effort to eat or drink. The nearest analogue to Croton tig. is Jatropha curcas, which pro- duces a perfect picture of cholera Asiatica, with great prostration and simultaneous vomiting and purging. The vomited matters look like rice-water or the white of an egg. There are also cramps in the calves and coldness of the body. The next similar drug is the Euphorbia corollata. This produces vomiting and purging, just like the previous remedy, with cold sweat all over the body. It has more marked than the other members of this group a peculiar mental state—the patient wants to die. Cascarilla has its abdominal symptoms relieved by warm drinks But it seems to be useful in a different class of cases from the forego- ing remedies. We use it when there are knotty stools covered with mucus, and associated with colic and burning just like the others. This remedy also has frequent pale red haemorrhages from the bowels. These haemorrhages do not consist of a simple oozing of blood, such as often follows a stool when haemorrhoids are present, nor is it a haemorrhage from the bowels from hepatic disease, but it comes from disease of the blood vessels. Yucca filamentosa has a predominance of the bilious symptoms over the gastric and intestinal. It has frontal or temporal headaches, fre- quent flushing of the face, yellow or sallow face, and tongue coated yellow or yellowish-white, and taking the imprint of the teeth. There are also dull aching about the centre of the liver, poor appetite, dis- tended abdomen which is sensitive to the touch, colic or colicky pains, tenesmus with frequent passage of flatus, frequent watery or yellowish- brown stools. Now let us study the action of these remedies on the skin. When Croton tiglium is applied to the skin it produces an erythema, which is soon followed by a group of vesicles which are almost confluent, and which burn and itch most intolerably. If the action of the drug is allowed to continue, these vesicles form a yellowish scab much resem- bling that of milk-crust, in which disease it may be indicated, espe- cially when the bowel-symptoms suit. Hippomane mancinella was first proved by Dr. Muir. Its power of producing vesicles has been utilized in scarlet fever. Its symptoms are these: Delirium; sore throat, with inability to swallow on account of the constriction in the throat and oesophagus; burning of the eyes made worse by closing the lids. EUPHORBIACEAE. 293 Yucca produces an erythematous redness of the skin. In two provers it produced a burning and swelling of the prepuce with red- ness of the meatus urinarius. An examination of allopathic text- books will show you that Yucca has been recommended for gonorrhoea. Euphorbium officinarum differs somewhat from the others. Like them, it produces an erythematous and vesicular eruption. Its chief value, however, arises from its action on the bones. It is used in dis- eases of these structures with burning pain, especially after the abuse of mercury. Ricinus communis has the effect of increasing the quantity of milk in nursing women. It is here similar to Urtica urens, which is an excellent remedy for absence of milk after confinement. Castor oil, when abused, is antidoted by two medicines, according to the respective characteristics, Bryonia and Nux vomica; Bryonia from a specific relation to the symptoms of Ricinus, and Nux from its relation to drastic remedies in general. LECTURE XXX. RANUNCULACEiE. Ranunculaceae. Aconite. Helleborus niger. Clematis erecta. Paeonia. Pulsatilla. Hydrastis. Staphisagria. Actea racemosa. Actea spicata. Radix coptidis. Ranunculus bulb. Ranunculus sceler. To-day we have on the board the Ranunculacece, an order of plants containing many medicines. It receives its name from the different varieties of the butter-cup. As a whole, the order seems to possess an acridity, and some of its members are slightly narcotic. From this order we obtain Aconite, Actea racemosa, Actea spicata, Radix coptidis, Ranunculus bulbosus, Ranunculus sceleratus, Hepatica, Pulsatilla, Hydrastis Canadensis, Clematis erecta, Staphisagria, Helleborus and Pczonia. We will have time to study only the principal of these. We will first consider Aconite. Aconitum Napellus. Aconitum napellus is the monkshood. Aconite itself means without dust. The plant has been so named from the botanical fact that it grows on dry rocks, with scarcely enough earth about to enable it to take root. This shows the hardiness of the plant. It is called the monkshood because of the shape of the flowers, which turn over and give the ap- pearance of a hood thrown over the head. Aconitum napellus contains an active principle called Aconitine, crystalline in some instances and amorphous in others. In the root of the Aconitum napellus is another principle called Napelline. Aconitine is also contained in one variety ACONITUM. 295 of the Staphisagria, the larkspur. It is also said that Helleborus con- tains Aconitic acid. I have heard, but with how much truth I cannot say, that some of the inhabitants of Persia eat the tops of the Aconitum ferox. It is also asserted (this, too, I cannot vouch for) that, in some parts of Switzerland, Aconite is grown in rows along the streets, and the tops are cut off and used as greens. This illustrates the fact that plants alter their properties from domestication. When taken in poisonous doses, Aconite acts as a depressant to the cerebro-spinal nervous system. It produces a sensation of numbness attended with pricking and tingling in the extremities, and even com- plete anaesthesia. At first the emotions are not at all impaired. It also affects the circulatory system. After the first sensation of diffused warmth is experienced, there follows an intense internal heat and pro- fuse hot sweat. At other times the skin becomes covered with a miliary rash, which itches intensely. The pulse and respirations are greatly accelerated. Secondarily, the surface of the body becomes cool, with cold clammy sweat, the pulse grows feeble, and death ends the scene. Aconite, in its action on the nerves differs from Cocculus Indicus, which early disturbs consciousness. This drug, moreover, produces a complete motor and not sensory paralysis. It differs also from Gelse- mium, Conium and Nux vomica, which early destroy motor rather than sensory activity. As regards its symptom of collapse, they resemble those of Camphor, and more nearly Veratrum album. But only Ve- ratrum has the characteristic purging and vomiting, with cold sweat on the forehead. Both Aconite and Nux cause tetanic convulsions, but they are only partial in Aconite, and are accompanied by great muscular weakness. Aconite produces two different sets of symptoms, entirely distinct in their character, and as separate as though the drug were composed of two substances, each developing its own symptoms. The second set of symptoms, that which is most thoroughly known, is the tendency of Aconite to develop fever and inflammation. This it does through its action on the sympathetic nervous system. We find it indicated in genuine inflammatory fever, in what is called synochal fever, otherwise termed sthenic fever. All these terms apply to a fever which has about it no quality of weakness or asthenia. The symptoms of the fevers calling for Aconite are these: There are usually dry heat of the skin, and full, hard, bounding pulse. This fever is always associated with anxiety. The mental symptoms and those which are local, Hahnemann 296 A CLINICAL MATERIA MEDICA. has told us, are the true guiding symptoms in the selection of Aconite. It cannot be the remedy unless there is present anxiety, restlessness and fear of death. The sweat which follows this fever is usually critical, and gives relief to all the symptoms. It is profuse, warm or even hot. It has been proven that Aconite does not produce any alteration in the quality of the blood; hence, you cannot expect it to be indicated in any form of fever in which there is a poison in the blood destroying that fluid or impairing its corpuscles, altering its plasma, or in any way changing its quality. The type of the Aconite fever is sthenic and continuous, and not intermittent or remittent. It has no symptom in its pathogenesis which points to intermittency. Beginning with the initial chill or chills, the dry heat follows and continues until sweat brings relief. Then the fever is over so far as Aconite is concerned. It has no typical return of these febrile attacks. Hence, you cannot give Aconite in intermittent fever. Then, again, it must be borne in mind that sometimes the fever is not the disease itself, but a symptom which is necessary for the proper development of the disease. You should no more attempt to lop off this fever by the administration of Aconite, than you would lop off one symptom in any other disease. When, then, fever is only a symptom, Aconite should not be given to control it. Take scarlatina for instance. The fever here may run high, the skin may be hot and dry, and the pulse hard. Superficially, Aconite appears to be indicated, yet you know, with the other symp- toms present, backache, vomiting, sore-throat and the existence of other cases of the disease in the neighborhood, that scarlatina is developing. You know, by removing this fever, you take away a symptom which is necessary for the proper development of the rash belonging to the disease. Therefore, Aconite is rarely to be thought of in scarlatina. There may be exceptional cases when the fever is disproportionately severe and the characteristic mental symptoms are present, in which case you may administer it, but nine cases out of ten would only be spoiled by the administration of Aconite. Again, a mistake is made in giving Aconite in typhoid types of fever to diminish the pulse and control the temperature. Aconite has no relation whatever to typhoid fever. It is here given from mere symp- tom practice and not through any knowledge of pathology and symp- tomatology. Let me beg of you not to commence this practice; it will only lead you to alternation. In traumatic or inflammatory fevers, Aconite must give way to other remedies unless this restlessness or anxiety is present. One of these ACONITUM. 297 remedies is Bryonia, which has full, hard pulse, increased action of the heart, dry skin and aggravation of all the symptoms by motion. The patient lies perfectly quiet. He is not at all restless. It is important that you distinguish between Aconite, Gelsemium and Apis in febrile states. I will therefore give you in detail the symp- toms and conditions which make the selection of one or the other of these remedies certain. If I repeat what has already been said, the repetition will only serve to impress the distinction between these remedies the more firmly in your minds. Aconite typifies the synochal fever; Gelsemium the remittent or intermittent; Apis the intermittent or typhoid. Aconite causes decided chill, followed by dry, hot skin and full, hard, bounding pulse; later, follows warm, profuse, critical sweat, with relief. Gelsemium causes partial chill, beginning in the hands or running up and down the spine; followed by general heat, most decided about the head and face. Sweat is gradual and moder- ate, but always gives relief. Apis causes a chill, which is followed by burning heat all over, or some places are hot and some cool. Heat is felt particularly in the abdomen. Skin is hot and dry, or alternately dry and moist. Sweat is absent or breaks out in spells, soon drying off. Under Aconite the pulse is, as stated, full, hard, bounding. Under Gelsemium it is full, flowing, but not hard. Under Apis it is accel- erated, full and strong, or fluttering, wiry and frequent. Aconite pre- supposes that the blood is not qualitatively altered. Gelsemium admits of any change which may favor depression. Apis tends towards tox- aemia, with a typhoid type. Aconite, therefore, is the remedy. only when the fever is sthenic; such as arises from exposure to dry, cold winds; from exposure after overheating; from cooling suddenly when warm and sweating, etc. In bilious fever it is indicated in the early stages when of the sthenic type, especially because it acts on the liver. It is also the remedy in inflammatory fever, whether traumatic or not, the type agreeing; particularly in full-blooded, robust individuals, who readily suffer from sudden active congestions. It bears no relation to the intermitting type of fever, and, when given during such a fever, acts only by subduing the heart's action, and' never curatively, hence never homoeopathically. Neither does it hold any relation to typhoid fever. Gelsemium is the remedy when the fever develops under cir- cumstances which favor a paresis of motor nerves of both voluntary and involuntary muscles. It corresponds to that stage in which the blood- vessels are dilated and full, but lack the firmness and resistance of a fully developed sthenic inflammation. Such a form of fever is accom- 298 A CLINICAL MATERIA MEDICA. panied by languor, muscular weakness, desire for absolute rest, and drowsiness. Under such conditions congestions might still be arterial, as under Aconite, but they exhibit a passivity which is sufficiently characteristic. The pulse is full, flowing, but not hard. So Gel- semium may be indicated in bilious fevers, the liver being passively con- gested. Again, it applies in typhoid forms, but never after the languor and drowsiness belonging to relaxation, and consequent passive con- gestion of the brain pass into great prostration and stupor. Apis has an apparent resemblance to the sthenic fever of Aconite in its hot skin, strong pulse, etc., and this is especially so in the beginning of erysipelatous inflammations, or, still more, in inflammation of serous or synovial membranes. But the tendency of the Apis is typhoid- ward or towards effusions; Aconite never either. Thus Aconite may suit the fever attending the initiation of a meningitis, pleuritis or synovitis; but its power ceases when the cri encephalique, dyspnoea and dull percussion, or puffy, doughy swelling about the joint, as the case may be, announces effusion. In its intermittent form of fever, Apis bears no resemblance to either Aconite or Gelsemium. Even in a rheumatic type in which Aconite and Apis both appear, the resem- blance is only superficial; for Apis either develops an erysipelatous inflammation, or causes burning-stinging pain and an exquisite sore- ness, all referable to the bloodvessels. In its lower forms Apis deserts Aconite and completely supersedes Gelsemium. It is indicated in genuine scarlatina, in diphtheria and in typhoid fever. There is a tendency to defibrination of the blood, and lastly to decomposition of the fluids. In such cases the anxious restlessness of Aconite and the irritability or drowsiness of Gelsemium are replaced by a fidgety rest- lessness and stupefaction. The excitement and delirium of Aconite and the semi-conscious muttering of Gelsemium are changed into a low muttering delirium and unconciousness. Arranging the respective symptoms according to the requirements of the Organon, we have each remedy characterized as follows: Aconite, anguish, despair, restless tossing about during the fever; fears he will die; throws off the clothes; pulse full, hard, bounding; skin hot, dry. All ends in copi- ous sweats. Gelsemium, irritable, sensitive; children sometimes wake- ful, nervous, even threatened with convulsions, or drowsy, eyelids heavy, look as if intoxicated; want to remain perfectly quiet. Chill up and down the back, followed by fever with increased drowsiness; pulse full, flowing. Sweat moderate, gradual, but giving relief. Apis mellifica, fidgety restlessness; wants to sleep, but so nervous, cannot; ACONITUM. 299 or low, muttering delirium; sopor. Chill begins in the knees or ab- domen, three p. m. ; heat, with dry skin or occasional transient spells of sweating; desire to uncover; great oppression of the chest; skin hot in some places and cool in others. Pulse accelerated and strong; or, as debility shows itself, wiry and frequent; intermittent, imper- ceptible. Belladonna comes in as another concordant remedy to Aconite. Belladonna, as we shall see in the future, does not act primarily on the vaso-motor nerves or sympathetic ganglia hence it does not control the calibre of the bloodvessels. It acts primarily on the cerebro- spinal nervous system, hence we find it indicated in fevers which begin with symptoms of the brain and spinal cord. We find it indicated in fever which begins with the Aco7iite type, but which by extension, has involved the brain. Thus we often find Belladonna following Aconite well. Belladonna requires that brain symptoms, such as starting from sleep, throbbing headache, hot head and cold body and extremities be present. Veratrum viride takes the place of Aconite in fever marking the onset of pneumonia, when there is great arterial excitement. The breathing is labored and difficult. When synochal fever fails to yield to Aconite, the best remedy then is Sulphur. The symptoms that will lead you to the selection of this remedy are these: Despite the administration of Aconite,the dry heat persists. Either no perspiration shows itself, or, if any, it is simply transient. The patient, at first sleepless and restless, becomes drowsy and answers questions slowly or permits an interval to elapse between your questions and his reply. The tongue becomes dry and the speech a little thick. The patient gives evidence of falling into a typhoid state owing to the continued exhaustion from this heat. Ferrum phosphoricum, of which I have already spoken more than once, should be distinguished from Aconite. It acts upon the blood- vessels, producing a sort of semi-paretic state, in which they become dilated as in the second stage of inflammation. The pulse is full and rather soft, and not hard or tense, as with Aconite. It is indicated in congestions of any part of the body when the discharges from that part are blood-streaked. This may be applied to dysentery, to haemop- tysis, and to secondary pneumonia. Arsenicum album, like Aconite, causes intense fever, with anxiety, fear of death, and restlessness; but the fever and inflammation of Arsenic are such as belong to intense local disease, to inflammation 300 A CLINICAL MATERIA MEDICA. progressing to the destruction of the part, to fever of a typhoid type with putrid discharges, etc. ~~Aconite may be used in inflammatory affections of the brain. You must, however, distinguish between an idiopathic cerebral inflamma- tion and one arising from deep-seated disease. Aconite can have but little influence over tubercular meningitis. But in meningitis or cere- bral congestion from lying with the head exposed to the direct rays of the sun, especially when asleep, it is the remedy, here being superior to either Glonoin or Belladonna. It may also be used when cerebral congestion results from a fit of anger. Aconite may further be indicated in sunstroke when the great heat has had a paralyzing effect on the circulation. At first the heart works harder. It then begins to lose its force and beat from 120 to 130 beats per minute. You may use Aconite in affections of the eyes, in conjunctivitis following surgical operations, or resulting from a foreign body in the eye. It is also indicated in inflammatory affections of the eyes, arising from exposure to dry cold winds. There is a great deal of heat and burning in the eye. The eye feels as if full of sand, and is exceed- ingly sensitive. The pains are so intense that the patient wishes to die; he declares that he cannot stand them. The eye-ball feels as if forced out of the orbit, and aches; this aching is worse when the affected part is moved or touched. Photophobia is intense. The pupils are contracted, and there is a blue circle around the cornea, and vio- lent aching in the balls as in episcleritis. Even glaucoma may de- mand Aconite when, in addition to the symptoms above enumerated, there are pains extending down the face, as in tic douloureux, especi- ally after exposure to intense cold or to cold winds or in rheumatic patients. If, however, Aconite does not relieve promptly, you must resort to other measures at once, as this disease may destroy sight in an incredibly short time. Sulphur is indicated in conjunctivitis from irritation of foreign bodies when Aconite fails. Spigelia has many pains similar to those of Aconite, especially in the left eye; but its inflammation is less general than in the case of Aconite. The other action of Aconite is very different from that already con- sidered. These symptoms belong more to the cerebro-spinal nervous system. First, we will speak of the symptoms of the mind itself. We find Aconite useful for mental disease or hysteria when there is par- ACONITUM. 301 ticular aversion to excitement, especially to busy streets. The patients dare not cross these streets because of fear that something will happen to them. This symptom is perfectly normal under some circum- stances, but when extreme, denotes over-excitement of the brain, com- mon enough in hysterical patients. They are anxious. They show an intolerance of music. They can bear no sounds, so sensitive are the ears. They imagine that, some part of the body is deformed, e. g., a limb displaced, lips too thick, features distorted, imagine they do all their thinking from the stomach. Sometimes such patients, during attacks of illness, have '' spells '' in which they predict the hour of death. You may sometimes note this symptom in puerperal fever. Coffea also has the symptom, predicts the hour of death. Further than this Aconite causes paralysis; a paralysis which may easily be remembered from two or three subjective symptoms; paraly- sis accompanied by coldness, numbness and tingling. Unless there is tingling in the affected part, we seldom find Aconite indicated. Even paralysis of both legs, paraplegia, may yield to Aconite with this char- acteristic coldness of the limbs and tingling. We may also use Aconite in various forms of local palsies, as facial paralysis, when associated with the above-mentioned symptoms, and when traceable to exposure to dry cold winds. Cannabis Indica and Staphisagria should be remembered in paralysis, with tingling in the affected parts; and Rhus tox., Sulphur, and Caus- ticum in paralysis from cold. The neuralgia for which Aconite is the remedy, is caused by exposure to dry cold winds. Especially is it indicated when there is violent con- gestion of the affected part, which is usually the face. The face will be red and swollen. The pains drive the patient almost to despair. There is usually tingling in the affected part. You may here compare Spigelia, which is useful in left-sided prosopalgia, with severe burning, sticking pains. The patient exhibits intense excitement and great in- tolerance of the pains. Colchicum is likewise indicated in left-sided prosopalgia. The pains are associated with a paralytic weakness of the muscles, but lack the severity of those of Spigelia. Amy I nitrate may be needed rather than Aconite in prosopalgia with much local congestion. Aconite is a very important remedy in the treatment of affections of the heart. The symptoms indicating it in these cases are numerous and important, and necessarily so, since Aconite so disturbs the blood- 302 A CLINICAL MATERIA MEDICA. flow, and also exerts a special action on the heart and its nerves. There are congestions to both heart and lungs, palpitation with anxiety, cardiac oppression, and even syncope. The palpitation is worse when walking. Lancinating stitches occur and prevent the patient from assuming an erect posture or taking a deep inspiration. Attacks of intense pain extend from the heart down the left arm, and are associ- ated with numbness and tingling in the fingers. In hypertrophy of the heart, Aconite is indicated by this numbness and tingling in the fingers. It is an uncomplicated hypertrophy of the heart only that you should give this remedy. In hypertrophy from valvular disease it may do great harm. You should here compare Aconite with Arnica, Aurum, Rhus tox., and Cactus grandiflorus. Kalmia and Rhus also have numbness and tingling in the left arm with heart disease. Aconite may be used in the first stages of pneumonia when the -fever is high and has been preceded by a chill. Symptoms of engorgement of the lungs are present. The cough is usually hard and dry and rather painful. At most, the expectoration is serous or watery, and a little blood-streaked, but not thick and blood-streaked. The patient is necessarily full of anxiety. Veratrum viride competes with Aconite in the incipiency of pneu- monia. It acts admirably when the pneumonic engorgement is severe, with violent excitement of the heart as indicated by rapid full pulse; nausea; on rising, faintness; tongue red down the centre. Bryonia comes in to take the place of Aconite, especially when hepat- ization has commenced. The cough is still hard and painful, and is associated with thicker expectoration. The anguish is now traceable to oppression of breathing and not to the fever; the patient prefers to lie still rather than to be tossed about. Aconite may also be indicated in pleurisy, in the very beginning be- fore there is any exudation; when there are sharp stitches on either side of the chest; when there are chills followed by febrile action; when the whole trouble has arisen from a checked perspiration or con- finement from the fresh air. In croup, whether catarrhal or membranous, you should give Aconite when the trouble has arisen from exposure to dry cold northwest winds. The patient is aroused from sleep with long suffocating attacks. The cough is of a hard, dry, barking character, and may be heard all over the house. There are great difficulty of breathing, anxiety, and high fever. ACONITUM. 303 Spongia is to be used when the breathing becomes '' sawing.'' The cough is still barking, harsh, and rasping. It is especially indicated in light complexioned blue-eyed children, when the trouble is worse before midnight. Hepar should be given if the cough is worse towards morning, and is associated with rattling of mucus. Sambucus is called for when there is spasm of the glottis. The breathing is of a wheezing crowing character, and is worse after mid- night and from lying with the head low. In haemoptysis calling for Aconite the blood is bright red. The trouble is always associated with anxiety and with fever. In haemop- tysis you may compare with Aconite the following: Millefolium, which has haemoptysis, with profuse flow of bright red blood, but without fever. Ledum for haemoptysis of drunkards or persons of a rheumatic con- stitution. The blood is bright red and foamy. Cactus grandiflorus for haemoptysis with strong throbbing of the heart. It has, however, less anxiety and less fever than has Aconite. Aconite is frequently of use in abdominal diseases, especially in in- flammatory affections of these parts. You may use it in gastritis or gastric catarrh with the usual attendant symptoms, when the trouble has been caused by exposure; also by checking of acute eruptions, or by sudden chilling from drinking ice water. You may also give it in inflammatory colic, the pains from which force the patient to bend double, yet are not relieved by any position. (Compare Colocynth.) This symptom is invaluable in the beginning of inflammatory pro- cesses within the abdomen, and also in some cases of ovarian dysmenor- rhoea. Aconite may be used in dysentery, especially when the disease occurs in the autumn when warm days are followed by cold nights; the stools are scanty, bloody and slimy, with much tenesmus. In this disease, Aconite is followed very well by Mercurius. The diarrhoea of Aconite is of inflammatory origin. The stools are watery, slimy and bloody. It usually appears in summer as the result of indulgence in cold drinks or from checked perspiration. Cholera infantum calls for Aconite when the stools look like chopped spinach, and the inflammatory symptoms already mentioned, are present. You should also remember Aconite in incarcerated hernia when in- flammation has started up in the strangulated bowel, with burning 3°4 A CLINICAL MATERIA MEDICA. pain in the affected part. There are also vomiting of bile, great anxiety and cold sweat. In the incipiency of nephritis, whether Bright's disease or not, Aconite has relieved when the patient complains of sharp cutting pains going in a circle from renal region around to the abdomen over each ilium. Coming now7 to the genital organs, we sometimes find Aconite indi- cated in dysmenorrhcea which has been supposed to result from thick- ening of the peritoneum over the ovaries. The characteristic colic, which I described a few minutes ago, is present. During pregnancy, Aconite may be administered for certain mental symptoms, such as fear of death, excitable temperament, etc. It may also be used for impending abortion caused by anger. During labor itself it may be given when the pains are unnaturally violent and frequent. The patient complains that she cannot breathe, that she cannot bear the pains. She is restless and anxious and the body is covered with a hot sweat. In the milk-fever, Aconite is to be given when the mammary glands are hot and swollen, and the .skin hot and dry. These symptoms are associated with restlessness and anxiety. Suppression of the lochia is an indication for Aconite, when caused by some violent emotion, and when associated with high fever, thirst and anxiety. The mammae are lax and the abdomen distended and sensitive to touch. Aconite is not often indicated in puerperal fevers because they are generally of septic origin, but for one form of child-bed fever it is the only remedy capable of subduing the whole affair within a few hours. The nurse, perhaps, has carelessly exposed the patient after a hard labor, has bathed her with too cold water or thoughtlessly changed her clothing without the necessary precautions, and there follow hot fever, thirst, etc., eyes glaring and wild, a sharp, anxious expression; abdomen distended and sensitive to touch, mammae lax and without milk; then you may give Aconite. While Aconite is not called for in scarlatina, still it may be used in that disease, when after the stage of desquamation, the child catches cold and acute Bright's disease results. The child starts up from sleep in perfect agony, with cold sweat on the forehead and with cold limbs. Dropsy is also present. In acute coryza you find Aconite indicated when the nasal mucous membrane is dry and hot, and when there is most violent throbbing ACONITUM. 305 headache, better in the open air. Or, the coryza may be fluent and hot with frequent sneezing. The muscles all over the body feel sore, so that sneezing forces him to support his chest; fever, etc.; all pro- voked, not by damp weather, not by exposure to any sort of atmos- phere capable of producing cold, as some teach, but by cold air, cold, dry winds, checked sweat. Here you may compare Nux vomica; colds caused by cold weather; nose stuffed and dry; throat feels rough as if scraped. Belladonna, if the head is intensely hot, throat red and tonsils swol- len. China, if there is headache from suppressed coryza, pains worse in the open air instead of better, as under Aconite. In skin diseases, Aconite is sometimes indicated. Though not a remedy for scarlatina, it is for scarlet-rash with high fever. In measles, it is early called for, when with the fever there are red eyes, restlessness, dry barking cough and itching and burning of the surfaec, which is covered by a rough miliary eruption. Sulphur is the proper remedy when Aconite has been abused. 20 LECTURE XXXI. ACTEA RACEMOSA, RANUNCULUS BULBOSUS AND RANUNCULUS SCELERATUS. Actea Racemosa. We have in the homoeopathic materia medica, two varieties of the Actea, Actea racemosa and Actea spicata. The last-named of these may be dismissed in a very few words. It acts upon the joints, espe- cially upon the smaller joints as those of the hands and feet. It is useful in rheumatism affecting these parts, especially if the hands and wrists are involved. Actea racemosa acts upon the cerebro-spinal nervous system, and especially on the motor nerves. It seems to have a decided influence over the nerves distributed to muscles, producing a perfect picture of myalgia. Actea racemosa is also valuable by reason of its reflex nervous symp- toms. It has neuralgia of any part of the body as a reflex symptom from uterine or ovarian disease. One of its most important symptoms arising from this cause is a sensation of heat on the top of the head just back of the centre. Other symptoms which you may note about the head are feeling as if the top of the head would fly off, sharp lan- cinating and neuralgiform pains in and over the eyes, supra-orbital pains shooting up to the top of the head. These symptoms indicate Actea racemosa in some of the diseases peculiar to women and in dis- eases of the eye proper. In any disease of the eye, when pains of the above-named character are present, Actea is one of the first remedies to be thought of. Spigelia has similar pains. Under this remedy the neuralgia comes and goes with the sun, that is it reaches its height at noon and subsides in the evening. The Actea pain is worse at night rather than during the day. The Spigelia pain begins in the back of the. head and comes forwards and settles over one or the other eye. This remedy also has a sensation as if the eye-ball was enormously large. When, however this last-named symptom is traceable to uterine displacement, Actea is preferable. ACTEA RACEMOSA. 307 Cedron is an invaluable remedy in neuralgiform affections when the pains involve the supra-orbital nerve and the eye, and are worse on the left side. The eye burns as if it were on fire. The pains recur regu- larly at the same hour each day. Another remedy to be mentioned in this connection is Kalmia lati- Jolia, which has supra-orbital neuralgia, worse on the right side. Actea may also be used for headache attended by a feeling as if the patient were going crazy. Especially is it of value when uterine symptoms are present. It is also called for when there is pain in the left infra-mammary region when dependent upon uterine disturbances. We come now to the action of Actea on the female sexual organs. It is indicated in labor or in threatened miscarriage when the pains fly across the abdomen from side to side {Lycopodium, from right to left; Ipecac, from left to right and associated with nausea). The pains seem to double the patient up. It may also be used in the early months of pregnancy for those pains in the abdominal walls which so distress the patient. When there is a great deal of soreness in the abdomen, the local ap- plication of a solution of Hamamelis is a good remedy. The labor-pains seem to be associated with fainting spells or with crying out in agony, so severe are they. In after-pains it is only useful when they are intense, when the patient is exceedingly sensitive and cannot tolerate them, and when they are worse in the groin. Actea may also be used in puerperal mania. The patient declares that she will go crazy, and her every action apparently indicates that she is keeping her word. She is suspicious. Her talk is nonsensical, and yet she seems to be conscious of what she is doing, and she says she cannot help it. Sometimes she has visions of rats, etc. These symptoms may also indicate the drug in delirium tremens. Here you may compare Lachesis, which has "awakening from sleep and springing from bed, not only with superhuman strength, but in great terror." Also Arsenicum, which often follows Lachesis when the patient is afraid to be left alone. Calcarea ostrearum, visions of rats and mice as soon as the patient closes her eyes. Another symptom that w7e find indicating Actea in labor is '' rigors 3o8 A CLINICAL MATERIA MEDICA. or nervous chills '' in the first stage of labor. Gelsemium is also useful in this condition. Actea racemosa does not cause phthisis, yet it may be one of the first remedies that we may use when the disease is not of hereditary origin, especially if the trouble has been brought on by exposure, or in any case in which the well-defined cough of Actea is present, and that is a dry, teasing cough, worse at night, with little or no sputum, and usually associated with pleurodynia. In pleurodynia associated with tuberculosis, you will find Guaiacum to be a remedy that rarely fails. You may use Actea in angina pectoris when the pains radiate all over the chest, and are associated with cerebral congestion and uncon- sciousness. The face is livid, and the left arm feels as if bound tightly to the body. Another use that we may make of Actea is in that condition known as spinal irritation. Especially is it indicated when the upper and lower cervical vertebrae, particularly the latter, are sensitive to pressure; hence, the patient will not lean back in her chair because of the un- easiness which it produces. This symptom of Actea is usually reflex from uterine irritation. Now we have several remedies similar to Actea in spinal irritation. One of these is Natrum mur., which also produces sensitiveness between the vertebrae. The main distinction between it and Actea is that under it the patient finds relief from lying flat on the back, and that, too, even when there is a uterine displacement. Another indication calling for Natrum mur. is a partial paralysis from weakness of the spine. Especially is it indicated when these symptoms arise from grief, anger, etc. Physostigma, or the Calabar bean, develops a perfect picture of spinal irritation. It produces all sorts of burning and twinging sensations referable to the spinal column, with numbness of the feet and hands and other parts of the body, crampy pains in the hands, sudden jerking of the limbs on dropping off to sleep. The muscles of the back become rigid, and even a tetanic condition may ensue. Agaricus muscarius produces a perfect picture of spinal irritation, with well-marked tingling or formication in the back, with itching or burning of the skin as if frostbitten, twitching of the muscles, espe- cially of the eyelids, and sensations in different parts of the body as if needles of ice were being thrust into the skin. This spinal irritation may develop a partial paralysis, in which case RANUNCULUS BULBOSUS. 309 we have two remedies to fall back upon. One of these is Zincum metal- licum. This produces a perfect picture of irritable spine, with aching in the back at about the last dorsal vertebra, which is worse from sitting than from either walking or lying. Along with this it produces weak- ness of the legs, especially at noon, when the patient is hungry. You should also remember that the spinal symptoms of Zinc are made worse by wine. The second remedy is Cocculus Indicus. This we use in females with weak spine when there is paralytic aching in the small of the back. The patient feels as if she could scarcely walk. Along with these symptoms there is also an empty, gone feeling in the abdomen, which feels as if hollow. Among men we do not find these symptoms present except as a result of sexual excesses, in which case Nux vomica is the remedy. Kobalt is of use for spinal irritation from sexual excesses when this symptom is present: Backache worse when sitting, with weakness in the legs. Ranunculus Bulbosus. Serous membranes. Ranunculus J Muscles. bulbosus. | Effects of alcohol. [ Skin. Compare with Aconite, Arnica, Cactus, Bryonia, Rhus, Arsenic, Mezereurn. We have two varieties of the Ranunculus to consider to-day. These are the Ranunculus bulbosus and the Ranunculus sceleratus. Now both of these plants possess a j uice or sap which is exceedingly irritating to the skin. When applied locally, it produces erythema followed later by an eruption which at first is vesicular in its character and attended by burning, smarting and itching. If the symptoms con- tinue by reason of the intensity of the action of the drug, ulceration and even gangrene of the parts follow, the gangrene being associated with fever and delirium. This is an extreme picture, yet it is one which may follow the prolonged use of some of the species of the Ranunculus plants. We shall now consider the Ranunculus bulbosus, and first as to its action on serous membranes. We may think of Ranunculus bulbosus in inflammation of serous membranes, particularly of the pleura or peritoneum, when there are acute stabbing pains in the chest in the 3io A CLINICAL MATERIA MEDICA. case of pleuritis, and accompanied by an effusion of serum into one or the other cavity, according as it is one or the other membrane in- flamed. Accompanying this effusion we find great anxiety, dyspnoea and distress, caused partly by the accumulation of fluid and partly by the anxiety from the pains themselves. Now these are symptoms not commonly known among the physicians, yet you will find that here Ranunculus will serve you as well as Apis, Bryonia or Sulphur, or even better than these, if the character of the pains just described is present. The second heading in the schema on the board is '' Muscles.'' We find Ranunculus acting here as a curative agent. It is especially in- dicated in rheumatism of the muscles, particularly in muscles about the trunk. Intercostal rheumatism yields far more quickly to this drug than to any other. There is usually a great deal of soreness to touchy and the muscles have a bruised feeling as if they had been pounded. I know that Aconite, Arnica or Bryonia is often given when Ranun- culus is indicated. Aconite may be the remedy in pleurodynia when there is high fever (which is not often), especially if you can trace the trouble to exposure to cold after being overheated. Ranunculus bulbosus may also be used in the case of persons who are subject to stitches about the chest in every change of weather. Again, it may be used for sore spots remaining in and about the chest after pneumonia. The characteristic sensation attending the Ranun- culus soreness is a feeling of subcutaneous ulceration, which is purely subjective. This symptom is also characteristic of Pulsatilla. Again, Ranunculus may be used for pains about the lungs from ad- hesions after pleurisy. The rheumatic pains of Ranunculus are worse in damp weather and particularly from a change of weather or change of temperature. Even a rheumatic headache having this aggravation, may call for Ranunculus. We may also find it indicated in diaphragmitis when there are sharp shooting pains from the hypochondria and epigastrium through to the back. Another remedy that I have found of service in this latter disease is Cactus grandiflorus, which is an excellent remedy for sharp pains in the diaphragm, particularly if there is a feeling as though a band were tied around the waist just marking out the attachments of the diaphragm to the borders of the ribs below. ranunculus sceleratus. 311 Next you should remember Ranunculus bulbosus as a remedy for the bad effects of excess in drink, in hiccough and even in epilepti- form attacks and delirium tremens. Lastly, we come to the action of the drug on the skin. Ranunculus bulbosus is useful in herpes zoster or zona. Vesicles appear on the skin and are filled with serum, and burn. Sometimes these vesicles have a bluish-black appearance. Especially is Ranunculus indicated when the trouble follows the course of the supra-orbital or intercostal nerves and is followed by sharp stitching pains. Here you may compare Rhus tox., Arsenicum and Mezereurn. Ranunculus may also produce pemphigus. Large blisters form which burst and leave raw surfaces. Again, you may use Ranunculus in eczema, attended by thickening of the skin and the formation of hard horny scabs. Here it is similar to Antimonium crudum, which also has horny ex- crescences or callosities on the soles of the feet. The ulcers which Ranunculus causes are flat and are attended with a great deal of stinging pain. The discharge is ichorous. Lastly, the action of Ranunculus on mucous membranes. It is one of the remedies which are useful in hay fever. You will find that there is smarting in the eyes; the eyelids burn and feel sore; the nose is stuffed up, especially towards evening, with pressure at the root of the nose and tingling and crawling sensation within its cavity. Some- times this sensation attacks the posterior nares, causing the patient to hawk and swallow, and endeavor in every way to scratch the affected part. Arsenicum and Silicea also have this symptom. You will notice, too, that there is with this hay fever, hoarseness, and very likely sharp stitching pains in and about the chest, general muscular soreness. The neck of the bladder may be affected, producing some burning in passing water. Sulphur does not follow Ranunculus well. Ranunculus Sceleratus. Ranunculus sceleratus. \ „„ . ' (. Skin. Compare with Natrum m., Arsenicum, Taraxacum, Rhus tox. Ranunculus sceleratus is more irritating in its action than is the Ra- nunculus bulbosus. In its action on the skin it produces a vesicular 312 A CLINICAL MATERIA MEDICA. eruption with thin, yellow, acrid discharge, something like the Ranun- culus bulbosus. It also develops more markedly large isolated blisters. When these burst, an ulcer is formed, the discharge from which is very acrid, making the surrounding parts sore. In stomacace, and sometimes even in diphtheria or in typhoid fever, you will find Ranunculus sceleratus indicated by the presence of de- nuded patches on the tongue, the remainder of the organ being coated. Thus we have the condition known as mapped tongue. Natrum mur. has this symptom and so have Arsenicum, Rhus tox., and Taraxacum, but none of these remedies have the same amount of burning and raw- ness that Ranunculus sceleratus has. The acridity of the drug differ- entiates it from all others. Like Ranunculus bulbosus, the Ranunculus sceleratus may be indicated in ordinary catarrhs with sneezing, fluent coryza, pains in joints, and burning on urination. LECTURE XXXII. HELLEBORUS AND STAPHISAGRIA. Helleborus. -< Helleborus. Sensorial depression. Dropsies. Sweet spirits of nitre, Phosphoric acid, Opium. Apis, Digitalis, Zin- cum (Brain), Tere- binthina. I propose considering first, to-day, Helleborus niger. This is also termed the Christmas rose, because it blossoms in midwinter. It has a dark brown root, which contains two active principles, Helleborin and Helleborein and an acid supposed to be Aconitic acid. The latter is said to be the poisonous constituent of the plant. It is an active cardiac poison, and also causes violent purging, vomiting, abdominal pains, and finally collapse This purgative action reminds one of Veratrum album, and the collapse, of Camphor, Carbo veg., China, etc. Veratrum album has not the apathy of Hellebore; Carbo veg. has cold feet and cold knees, rarely unconsciousness; Camphor has most prominently the coldness, sometimes with an internal feeling of heat, impelling the patient to throw off the clothes. The Helleborin is either inoperative, or, according to some authors, exerts a narcotic influence, and produces paresis of both sensation and motion. The action of Helleborus has been marked out for you on the board. It acts on the sensorium, blunting it, producing sopor; also typhoid symptoms, paralysis of muscles, collapse, and lastly dropsies. Before going any further I wish to say that by collapse I mean not a simple weakness, but a condition in which there is a positive diminution of temperature, so that the thermometer, instead of registering 98^° reg- isters 960, or thereabouts, according to the intensity of the collapse. In its action on the sensorium we find that it blunts or depresses sensorial activity. This condition is exhibited in a variety of symp- toms; for instance, we note diminished power of the mind over the 3H A CLINICAL MATERIA MEDICA. body; the patient is slow in answering questions, as though he did not comprehend what was asked of him; he sees imperfectly, or does not seem to comprehend what he sees; hearing is imperfect; taste is absent, or nearly so; he has the desire to work or to occupy himself, but lacks the muscular strength to do so. So you see that all the senses are benumbed by the action of Helleborus. Even what has been termed the muscular sense is affected by it. Muscles do not obey the will readily unless the mind is strongly exerted. If, for instance, the pa- tient is holding anything in his hand and you speak to him, and so divert his mind, the muscles in action relax and he drops what he is holding. The heart muscle even does not escape these paretic effects, so we have slow action of that organ. The patient feels a heaviness or weight over the entire body. There is a pressing headache of a stupefying character. Sometimes there is a sensation as though the contents of the head were bulging at the forehead and eyes. Thus, you see that Belladonna is not the only remedy that has this sensation, as though the brain were being pushed through the forehead. The face is expressive of the stupidity under which the patient is laboring. We may find Hellebore indicated in typhoid fever, or in other con- ditions in which this sensorial depression, with the symptoms already enumerated, is present. In these cases you will also note the follow- ing symptoms: There is a dark soot about the nostrils; the nostrils are dry; the tongue is yellow and dry, with red edges; the breath is horribly offensive; drinks roll audibly into the stomach. The fever accompanying these symptoms is most marked in the afternoon, from 4 to 8 p. M. The face is at times pale and almost cold, and the pulse faint, weak, and almost imperceptible. There is also meaningless picking at the lips or clothing. In this sensorial depression Helleborus is similar to Phosphoric acid, Sweet spirits of nitre and Opium. Like Phosphoric acid, it has sen- sorial depression, apathy, and perfect indifference. The patient is wholly indifferent as to his fate; he cares not whether he lives or dies. The difference between the two drugs is this: Under Phosphoric acid there is drowsiness from which the patient is easily aroused, and then is perfectly conscious; this is not the case with Helleborus, which has conditions more nearly approaching the stupor of Opium. Phos- phoric acid lacks the complete muscular relaxation belonging to Helle- borus. It also has not so ma'rked black soot about the nostrils. Sweet spirits of nitre is a remedy recommended by Hahnemann in these cases of typhoid fever when the key-note to the whole case is sen- HELLEBORUS. 315 sorial apathy, there being, of course, no other symptoms present to in- dicate any other remedy. The patient seems to be in a sort of torpor, from which he may, by exertion, be aroused, but he falls immediately back into the same indifference. In these cases Hahnemann dissolved a few drops of the crude drug in a glass half-full of water and adminis- tered it every two or three hours until reaction was manifested or some other drug indicated. You will find that Sweet spirits of nitre and Phosphoric acid differ from Helleborus in degree only, Sweet spirits of nitre having the apathy the lightest, Phosphoric acid comes next, wdiile Helleborus has it most marked. Opium, the last drug on the list, you will recognize at once as similar to Helleborus. The cerebral congestion is more profound under the Opium. The breathing is loud and stertorous. This symptom is not marked in Helleborus. Then too, the face is dark or brownish-red, or often blue. Under Helleborus the face is pale, and often cold or colder than natural, and at times livid and covered with a cold sweat. The pulse will help you to discriminate between these two remedies, it being full and slow under Opium, and small, weak, and almost imper- ceptible under Helleborus. Arnica is also to be thought of as a remedy producing this drowsy stupid state. Hydrocyanic acid and Cina also have the symptom, "drinks roll audibly into the stomach." Cina has it in whooping-cough. But when it occurs in approaching paralysis of the lungs and brain, Hydro- cyanic acid is the best remedy. In muscular exhaustion you may compare Helleborus with Muriatic acid, Opium, Gelsemium, Saponin, Conium, Curare, and Kali carb. Next, we find Helleborus called for in meningitis when exudation has taken place. You have present all or some of the symptoms of sensorial apathy already mentioned, showing you the depressed condi- tion of the system. In addition you have shooting pains in the head. If the patient is a child, it will, of course, be unable to describe to you this last symptom, but you will notice by the sudden screaming or crying out that it has these sharp, shooting pains. The child bores its head into the pillow; the head is hot, and the forehead wrinkled from contraction of the corrugator supercilli. There is automatic motion of one arm and one foot. This automatic motion may recur at regular intervals. I remember one case in which, every three minutes, the child's head was jerked to one side, the arm thrown up over the head; it would next utter a half-pitiful cry, and then quiet down again. 3i6 A CLINICAL MATERIA MEDICA. In the Helleborus child, the eyeballs are drawn upwards, so that you can scarcely see the cornea; the face flushes up, and then gradu- ally pales off. When offered a drink of water the child seizes the proffered glass with avidity, as though it were thirsty; this it does, not only on account of the thirst, but also because of the'nervousness. The bowels are usually constipated, or, if there is any stool, it is white, scanty, and jelly-like. The urine is dark, scanty, and loaded with albumen. The nearest remedy to Helleborus in tubercular meningitis is Apis. This has symptoms of irritability more marked than under Helleborus, which has, characteristically, sensorial depression. In Apis we often find spasms of the flexors, so that the big toes are drawn upwards. This has not been noticed under Helleborus. Digitalis is very similar to Helleborus in these dropsies of the brain, in that both remedies cause great depression of the sensorium, both are suited to post-scarlatinal dropsy, and both cause meningitis with effu- sion. Digitalis is to be chosen by the scanty, albuminous urine, and by its characteristically slow pulse, which may be even slower than the beating of the heart. In addition to these symptoms there may be a cold sweat on the surface of the body. Zincurn is useful in cases w7here one of the exanthemata has been checked, or has not been developed properly. The child is so ener- vated that it has not sufficient strength to develop an eruption. It arouses from sleep as if in fear; it has constant fidgety motion of the feet. Other forms of dropsy in which Helleborus is indicated are general dropsy or anasarca, and especially ascites. Here you may give Helle- borus when the trouble has arisen from post-scarlatinal nephritis. The urine is dark and scanty, or smoky from the admixture of decomposed blood. On standing it deposits a sediment looking like coffee-grounds. The stool contains jelly-like mucus, and is passed with much straining. The nearest remedy here is Terebinthina, which cures dropsy de- pendent on congestion of the kidneys, as indicated by dull aching in the renal region and by the smoky7 looking urine. As illustrative further of the depression of Helleborus, I may men- tion its successful employment by me in a case of shock from a blow on the head. Arnica had failed, and the patient became drowsy; one pupil was larger than the other; the patient answered questions slowly as if comprehension was imperfect; one leg was dragged in walking. STAPHISAGRIA. 317 The pulse was scarcely fifty per minute. The patient was worse from 4 to 8 P. M. Staphisagria. < V Colocynth. Causticum. Staphisagria. f 1. Blood.— Sycosis, Scurvy. 2. Loss of Fluids. 3. Organs. Similar to Nux vom.. Mercurius, Thuja, Cistus Can., Colocynthis, Chamom. Staphisagria is indicated in the first place in patients who appear pale, and are worn out and exhausted, especially as regards their ner- vous system. Both brain and spinal cord are weakened under its in- fluence. The face is rather sunken, the nose is peaked and pointed, and the eyes are sunken and surrounded by blue rings. Mentally, the Staphisagria patient as a child is rather impetuous and irritable, re- minding one strongly of Chamomilla. As an adult, the Staphisagria patient is hypochondriacal. There may be one of several causes pro- ducing this last-named mental state when this remedy is indicated. First, sexual excesses. We find it called for in these hypochondriacal moods after self-abuse, and also when this mental state occurs in young men and young women as a result of permitting the mind to dwell too much on sexual subjects. Owing to his bad habit the boy becomes apathetic and gloomy, and has this very complexion and sunken face that I have described. He rather prefers solitude, and is shy of the opposite sex. Locally, there is to be noted an irritability of the pros- tatic portion of the urethra. This state of affairs is seldom the result of excessive sexual intercourse. Platina was recommended by Grauvogl as a drug capable of curing spasms or convulsions, emaciation, and that train of symptoms follow- ing prepubic abuse of the sexual organs. Still another remedy is Caladium, which is to be thought of when, from masturbation, the glans penis is as flabby as a rag. The prepuce, when it is withdrawn behind the glans penis, remains there, not having contractility enough to replace itself. Nocturnal emissions occur either without dreams or with dreams that are foreign to the nature of sexual subjects. V 318 A CLINICAL MATERIA MEDICA. Other remedies indicated in this condition are Dioscorea and Gel- semium; and that well-known group to which I have already referred in a previous lecture, Nux vomica, Sulphur, Calcarea ostrearum and Lycopodium. Among the new remedies, Bromide of Potassium or Kali bromatum has been suggested. I have seen it do good when there was mental depression and weakness of the legs after self-abuse. In the female, in whom masturbation is not so common, w7e find ovarian symptoms resulting from the habit. Staphisagria becomes the remedy when these organs are in a state of irritability, especially in nervous excitable women. It may also be used in women of this class when these symptoms occur in the prolonged absence of their hus- bands. Still other mental symptoms belonging to Staphisagria, and symp- toms', too, of a different type from those just mentioned, are the fol- lowing: Easily excited to anger, sensitive to the least impression, takes offence at every little meant or unmeant insult. We have Staphisagria indicated in what I have already termed a mental colic; that is crampy pains in the abdomen following a fit of anger, just as we found present under Chamomilla and Colocynth. Chamomilla is called for in these cases by the association with the colic of hot face, red cheeks and hot perspiration; and Colocynth, by the severe pains causing the patient to double up for relief. Staphis- agria is here complementary to Colocynth, stepping in to complete the cure when Colocynth is insufficient. We also find Staphisagria indicated in diseases of the skin and of the bones. This drug has long been used as a local wash to destroy lice or vermin. You may use Staphisagria internally when there ap- pears on the skin an eczematous eruption. This may occur on the head, face or any other part of the body, but especially on the former two. This eruption is usually dry, and formed of very thick scabs, and itches violently, this last being an indication for the local applica- tion of Staphisagria. The peculiarity of this itching is, that when scratching stops it in one place, it goes to another. At other times these scabs are moist, and are yellowish in color and very offensive, even breeding lice. Thus you see Staphisagria is suited to crusta lactea or eczema capitis. Again this drug may be indicated in children who are weak and broken down as the result of a syphilitic or sycotic inheritance. In such children you almost always find the teeth decaying rapidly. Scarcely are the milk-teeth full grown, than they become black in STAPHISAGRIA. 319 creases or spots and crumble away. In this respect Staphisagria rivals Kreosote, than which there is no remedy serves better for the premature decay of the milk-teeth, when they first become yellow, then dark and finally decay. Next to these remedies you may think of Antimonium crudum, and in other cases still, Chamomilla and Coffea. In the Staphisagria patient the gums are unhealthy, swollen, spongy and bleed easily when touched by the food or by the finger, this con- dition being associated with painful swelling of the submaxillary glands. It is especially indicated after the abuse of Mercury. Staphisagria is useful in children suffering from inflammation of the eyes, particularly of the lids with hardened styes. For those little cystic tumors which form in the eyelids midway be- tween the inner and outer surfaces, Graphites is the proper remedy. These Staphisagria children have an eczematous eruption on the ears. Yellow scabs form about the ears. The exudation from these is bloody and seems to cause rawness of the skin. Still further, we find Staphisagria affecting the bones. It causes swelling of the periosteum with subsequent suppuration. It also produces on the skin fig-warts or condylomata. These are usually pediculated. This symptom places Staphisagria among the sycotic remedies. Thus we find it quite the companion of Thuja, being preferable to that remedy when there are present the form of eruption already mentioned, the crumbling of the teeth and the pedicu- lated condylomata. In some cases we find it indicated in syphilitic ulceration after the abuse of Mercury, the discharge being thin and acrid. An examina- tion with the probe reveals diseased bone beneath. We have several remedies similar to Staphisagria in bone affections, whether of syphilitic or scrofulous origin. One of them is Stillingia. This is of great use in syphilitic affections of the long bones, such as the femur, tibia, humerus, etc., in periostitis or in ostitis, the pains being worse at night and in damp weather. In addition to this you almost always find an excoriating coryza, the well-known syphilitic ozaena. Another remedy is Mercurius. Still another is Kali hydriodicum, especially when there is a combination of syphilis and mercury in the case. Strontiana carb. is suited more to the scrofulous constitution. It is indicated in osteitis, particularly of the femur, with ulcers discharging 320 A CLINICAL MATERIA MEDICA. more or less broken-down bone. With the bone trouble there is apt to be a profuse exhausting diarrhoea almost such as would come with hectic fever. Another remedy is Chloride of Gold and Platinum wdiich is useful for either caries or necrosis. Still another is Gettysburg Salts, which owes its effectiveness to the carbonate of lithia it contains. It is useful in caries of the vertebrae and of the hip-joint. Another use of Staphisagria is found in its application to gout. It is not so useful for the acute paroxysms as it is when gout becomes systemic; when urate of soda instead of being eliminated by the kid- neys is deposited in the various joints and organs of the body, pro- ducing arthritic nodes. It is also indicated in arthritic ophthalmia. The eyes burn and feel very dry, notwithstanding which there are smarting and profuse lachrymation. The pains go from the eyes into the teeth. In these gouty affections of the eyes, Colocynth is also a good remedy. Upon the stomach and bowels Staphisagria acts, seeming to produce a relaxation of the stomach so that that organ appears to hang down flabby and weak. This same symptom you will find under Ipecacu- anha. There is a desire for brandy, wine or something stimulating. Such patients are subject to colic, which greatly resembles that of Colocynth. You must also remember Staphisagria as a remedy in colic following operations about the abdomen. In diarrhoea it is indicated w7hen, in children, the disorder is asso- ciated with a peculiar form of stomacace; the tongue and gums are white and spongy, while there are cutting pains before and after stool, with a great deal of tenesmus of the rectum during stool, and escape of flatus, which is usually hot and smells like rotten eggs (here being similar to Chamomilla), stool being renewred by any attempt to take food or drink. In its action on the female organs, Staphisagria causes prolapsus uteri, and this prolapsus is almost always associated with a flabby condition of the stomach. The whole abdomen—contents and pari- etes—feels as if it would drop, so relaxed is it. If you investigate thoroughly, you will find that disappointed love or permitting the mind to dwell on sexual subjects has favored this relaxation. The leucor- rhcea which accompanies this condition is yellow and excoriating. LECTURE XXXIII. PULSATILLA. f Bloodvessels. _, . .„ Mucous membranes. Pulsatilla. < „ bynovial membranes. [_ Organs. Compare with Bryonia, Nux vom., Ant. crud., Ipecac, Sulph., Sulph. ac, Arsenic, Colchicum, Kali bi., Caulophyllum, Ignatia, Actea, Helo- nias, Hamamelis, Sepia. To-day we have to study Pulsatilla. The species which I shall consider is the Pulsatilla of Hahnemann, the Pulsatilla pratensis and not the American plant, the Pulsatilla Nuttalliana. There is some little difference in action between the two drugs. The "pratensis" has been better proved. The concordant remedies of this drug are almost without number. The reason for this is that it is a well-proved remedy, and one, too, that is often indicated. Its complementary remedies are Sulphuric acid and Lycopodium. Its antidotes are Chamomilla, Coffea, Ignatia and Nux vomica. The relation of Pulsatilla to Sulphuric acid calls for particular note. The latter remedy follows the former in gastric troubles. Pulsatilla also has an antidotal effect to Sulphuric acid. When this acid has been used for the cure of the appetite for liquor, Pulsatilla has been proposed as the remedy best suited for the diarrhoea which ensues. Pulsatilla pratensis is a pretty little flower belonging to the anemone. It has been called the wind-flower, and its name is in keeping with its symptoms, as they are as fickle as the wind. Changeableness of the symptoms is characteristic of the drug. This is especially marked in the haemorrhages, which now seemingly stop and in a few hours re- turn. It is also true of the diarrhoea, the stools continually changing their appearance—at one time being green, at another mixed with yellow, and at still another slimy. So, too, are the mental symptoms of the same fickle nature, the pa- tient now being irritable, then tearful, and again mild and pleasant. These are illustrations of the comparisons that I have stated. 21 322 A CLINICAL MATERIA MEDICA. Pulsatilla seems to be principally adapted to the female organism, although it also effects men as well as women. It is one of those reme- dies which we are apt to select by the predominance of the mental symptoms. It is especially indicated in patients of a mild, tearful disposition, having a rather slow, phlegmatic temperament. They are never irascible, although at times peevish. Thus, in the case of a child with gastric ailment, Pulsatilla may be used when it is peevish, pale, chilly, it is satisfied with nothing. That is not the Nux vomica condition, nor is it like Chamomilla, both of which remedies have de- cidedly more violence with their anger. The Pulsatilla woman is tearful, easily discouraged. Sometimes she is full of anxiety, with forebodings of some impending disaster. This anxiety comes from the epigastrium and is very likely associated with indigestion. It is often accompanied with chattering of the teeth, palpitation of the heart and flushes of heat. These are the main mental symptoms of Pulsatilla. They are present, more or less, in every disease in which it is the remedy. In these mental symptoms you should compare Sepia, which, you will recall, has a similar mental state; but it differs from Pulsatilla in the presence of irritability and anger. There is also indifference to her household affairs, to which she was formerly attentive. Natrum muriaticum also has tearful disposition similar to that of Pulsatilla, but with this difference: Consolation under Natrum mur. aggravates, while under Pulsatilla the patient seeks consolation. Stannum likewise has this tearful disposition. The patient is very much discouraged, or is tearful over his chest symptoms. He fears that he will go into a decline. The Ignatia patient is sad, but she hides her grief from others. Especially is Pulsatilla called for in chlorotic or anaemic women, when they complain always of a feeling of chill, and despite this chil- liness, they find relief for many of their symptoms in the open air. They cannot tolerate the close room. The pains from which they suffer seem to be accompanied by chilliness. This chilliness is more marked the more decided the pains are. The mental symptoms already mentioned are present. Especially is Pulsatilla the remedy w7hen chlorosis has been complicated by the abuse of iron or quinine. Chlo- rosis, coming to you from allopathic hands after the failure of iron and quinine, showing you that these remedies are not suitable to the case, will find its first, if not its only remedy, in Pulsatilla. You will frequently find this hint of service to you in practice, not only in chlo- PULSATILLA. 323 rosis, but in other affections as well when they arise, not so much from local disease as from a general defective state of nutrition. The whole system is worn out. Every tissue is relaxed. She suffers from changes of position in the uterus. The menses are late and scanty, dirk, clotted or changeable in character. Pulsatilla does not always cure after abuse of iron. But it stands in the same relation to this substance that Nux vomica does to the abuse of drastic purgatives, and Camphor to Cantharides. To understand how these phenomena of Pulsatilla are caused, whether in women, where they are most frequently met with, or excep- tionally in men, you must remember that the drug acts upon the vas- cular system, especially upon the right heart, and upon the veins and capillaries. Thus we find that whatever weakens the venous portion of the circulation, whatever retards the return of blood to the heart, must of course provoke just the class of symptoms for which Pulsatilla may be indicated. We know, for instance, that a warm, close room will provoke these symptoms. If you should sit in a close room or in one whose temperature is too high, the veins will become tortuous and there will be some oppression about the chest and retardation of the heart's action. These same symptoms occurring in disease suggest Pulsatilla. It acts on the right heart more than on the left, conse- quently, despite the chilliness which arises from the anaemia, the open air acts as a stimulus to the venous circulation, which improves the symptoms depending upon the sluggish flow of blood. You will find many symptoms throughout the entire body calling for Pulsatilla when there is this disturbance in the venous circulation. You will find in the chest a feeling of soreness referred to either sub- ' clavicular region, to the apex of one or the other lung, soreness which is felt when the patient lies on that side or presses against the left chest. This soreness seems to involve the muscular structures about the shoulder and even down the arm of the affected side. This symptom indicates venous congestion, or, at least, sluggish circulation through the upper part of the left lung. It has been a valuable symptom to me and to many physicians in the incipiency of tuberculosis, especially in women of the Pulsatilla temperament. Along with this soreness in the lung there may be some cough with expectoration. Although there may be no symptoms indicating the positive existence of tubercular in- < filtration we will have other symptoms indicating the onset of the. disease. Pulsatilla has several times relieved these cases. Then, too, we have Pulsatilla indicated in varicose veins, whether 324 A CLINICAL MATERIA MEDICA. occurring on the limbs or about the testicle (varicocele). The affected parts are bluish and annoy the patient by the soreness and stinging pains in them. The epistaxis, when Pulsatilla is indicated, is of a passive character. The flow comes steadily, but it is not bright red or does not come in ' gushes as it does in epistaxis dependent upon arterial lesions. It often i occurs vicariously, taking the place of the menses. The same is true of the blood-spitting or haemoptysis, which is either associated with this soreness or passive congestion of the chest or is dependent upon suppressed menstruation. In these venous symptoms Pulsatilla has an important analogue, namely, Hamamelis, which vies with it here. Before Hamamelis was proved Pulsatilla was the only remedy we could depend upon in the class of symptoms enumerated. Hamamelis is the preferable drug in varicose veins unless constitutional symptoms call for Pulsatilla, espe- cially in the case of varicocele. Varicocele has been cured by Hama metis applied externally and taken internally. The great character- istic of this drug, and that which makes its choice certain, is soreness of the affected part. It is a soreness which is not exactly the bruised feeling of Arnica ; it is not the sensitive soreness of Lachesis ; nor the stinging soreness of Apis; but it is that sore feeling which belongs to venous congestion. You may apply Hamamelis successfully in any con- dition in which that is present. I have often made use of the drug in pregnancy, when varicose veins appeared over the abdomen, and when the patient could not make any motion without experiencing a bruised sore feeling. Hamamelis is not the panacea which druggists would have us believe. It does not cure everything, sprains, scalds, etc., but it does cure the class of symptoms I have mentioned. Another concordant remedy of Pulsatilla is Lilium tigrinum, which, like the former, affects the right heart, producing engorgement of the veins, relief in the open air, scanty menses, and taste of blood in the mouth. But it differs from Pulsatilla in the decided tendency to pro- lapsus uteri, with bearing down, relieved by supporting the abdomen, or by crossing the limbs. Also, when Lilium is indicated, there is present a sharp pain, extending from the left nipple through the chest to the back. Another analogue is Sepia, which has many of the Pulsatilla symp- toms. It, too, is indicated in anaemia and chlorosis, and it also has this mild tearful temperament, but there is a difference in the mental symptoms. With Sepia there may be irritability or vehemence at PULSATILLA. 325 times. The Sepia patient has complete aversion to her usual house- hold duties. Let us now consider the action of Pulsatilla on mucous membranes. This is easily remembered. It produces a catarrhal inflammation of the mucous membrane, and this ends in the production of bland yellow or yellowish-green mucus. Now you have an indication which you may apply to any mucous membrane. Conjunctivitis calls for Pulsatilla when the discharge is thick, yellow or yellowish-green, and bland; hence, it is not indicated in the begin- ning, but during the course of the matured disease. It is an invalu- able remedy in the ophthalmia after measles and in purulent ophthal- mia, and in ophthalmia neonatorum, or the ophthalmia of the new born, whether these troubles are of gonorrhoeal origin or not, when the discharge is of the character just described. Its analogue here is Argentum nitricum, which has the same symptoms precisely, only more marked. It is to be used after the failure of Pulsatilla. Mercurius corrosivus is suggested in cases which, despite Argentum nitricum, threaten to ulcerate and perforate the cornea. These are not by any means the only eye symptoms of Pulsatilla. Dr. George S. Norton, of New York, published in the Hahnemannian Monthly, some years ago, a paper on the use of this remedy in diseases of the eye. This paper covered some six or eight pages. In addition to the conjunctival inflammation just noticed, Pulsatilla causes: Obscu- ration of vision, with vertigo and nausea, diplopia, starry apparitions, circles of fire, etc. (these generally being reflex symptoms); pustules on the cornea, with very little dread of light, but with lachrymation, worse in the open air; pressing, stinging pains in the eye; lids swollen; styes, relieved when in the open air; margin of lids inflamed and swollen, but not excoriated. Pulsatilla is also an excellent remedy in small central corneal ulcers, with no vascular supply, especially when occurring in scrofulous sub- jects. It may still further be used in lachrymation from disease of the lachrymal duct when the symptoms just enumerated are present. Pulsatilla also affects the nasal mucous membrane, and develops symptoms which indicate it in the advanced stages of a cold. It should not be given in the beginning of a cold unless the temperament and other symptoms decide, because the sneezing and the serous excoriating discharge are not characteristic Pulsatilla symptoms. But when you find a nasal catarrh "ripened," that is, when the nasal discharge is 326 A CLINICAL MATERIA MEDICA. thick, muco-purulent, yellowish or yellowish-green, and not excoriat- ing in the least, you have a perfect picture of Pulsatilla. In chronic nasal catarrh you may give Pulsatilla if the discharge is of this character. You must give the drug frequently and persistently, in order to cure. In addition to the symptoms already enumerated, there is still another, namely, loss of taste and smell. There is a remedy known as Cyclamen, which is very similar to Pulsatilla in its symptomatology. It seems to be suited to nasal catarrh when there are loss of taste and smell, and this thick discharge just like that of Pulsatilla ; but it has, in addition, spasmodic sneezing. Penthorum sedoides is useful in the incipiency of coryza when there is rawness in the nose and throat. The patient complains of a constant wet feeling in the nose, but without coryza. Later, there is a forma- tion of thick purulent discharge, just as in Pulsatilla. Spigelia is one of our best remedies for catarrh of the posterior nares. The symptoms indicating it are profuse discharge of mucus through the posterior nares; nasal mucus passes off only through the posterior nares. This drug has accomplished some good cures in the hands of Dr. Aug. Korndoerfer. Hydrastis is also suited to post-nasal catarrh. The discharge is of a thin watery character, and is attended with a great deal of burning and rawness, together with a sensation as of a hair in the nostrils. Pulsatilla is an invaluable remedy in affections of the ears. In otitis externa you may use it when the external ear is hot, red, and swollen, and there are darting, tearing, pulsating pains, which are worse at night. In otitis media it is also useful when there is a profuse thick yel- lowish or yellowish-green discharge from the ear. Pulsatilla is one of our leading remedies in catarrhal otitis. There is deafness, with a feeling as if the ears were stopped up, with rushing noises in the ears, isochronous with the pulse. Silicea is the nearest remedy to Pulsatilla in catarrhal otorrhcea. Belladonna and Mercurius have a deeper action than Pulsatilla, acting on the cellular tissues. Chamomilla is similar to Pulsatilla in the ear symptoms, but the pains are more violent, and are attended with red cheeks; the patient cannot bear pain. Plantago major is to be thought of when earache is associated with toothache. Tellurium causes catarrh of the middle ear, which may7 even involve PULSATILLA. 327 the internal ear or the brain, or even penetrate into the cells of the mastoid process and establish an abscess there. Pus forms in the middle ear, and finally, perforating the membrana tympani, escapes externally. The resultant discharge is thin, acrid, causing blisters wherever it touches and smells like fish-brine. In catarrh of the throat you will find Pulsatilla sometimes, though not frequently, the remedy. It would here be indicated by the appear- ance of the parts. There are a marked redness of the tonsils and a varicose condition of the bloodvessels of the parts, and the fauces have a dark red or purplish hue. There are also stinging pains in the throat (here reminding you of Apis), worse usually from swallowing saliva or after eating food. Leaving the pharynx we next come to the stomach, of which organ Pulsatilla produces a catarrh. It is indicated in this disease when the tongue is coated with a thick rough white fur. The mouth feels dry, and yet there is not much thirst, thirstlessness being a characteristic of the remedy. There are also nausea, and sometimes vomiting, the vom- ited matters consisting either of food or mucus, and also of bile. The food vomited may have been that eaten a long time before, thus showing the weak digestion of the remedy. A feeling of fulness and heaviness in the stomach after eating, sometimes associated with a feeling of rawness in the stomach as from ulceration. This last is merely a sub- jective symptom and is a common sensation in Pulsatilla. Usually there is diarrhoea, with slimy or watery stools, and worse after mid- night. Attending these gastric symptoms is heartburn, and not very often water-brash. When water-brash calls for Pulsatilla there is a putrid taste in the mouth in the morning, better after drinking. The patient craves lemonade. He may complain that his mouth is dry, yet it seems to contain plenty of mucus. Other symptoms experienced are feeling of weight in the epigastrium an hour after eating, relieved by eating again; feeling in the oesophagus as if food was lying there (also China, Abies); throbbing in the epigastrium; much flatulence which moves about, causing pinching pains and rumbling, worse on awaking or just after supper. Now these are the symptoms calling for this remedy in gastric catarrh. What are the exciting causes? First of all and most important, it is called for when the trouble has arisen after partaking of fatty food or of pastry. It is also indicated in gastric catarrh arising from a mixed diet, as turkey, vegetables, coffee, etc.; also after chilling the stomach with ice-cream or ice-water, es- pecially if the stomach is warm. In still other cases it may be indi- 328 A CLINICAL MATERIA MEDICA. cated after getting wet, especially after getting the feet wet when sup- pression of the menses ensues. It will be well for you if now I differentiate this remedy from others commonly used in these dyspeptic symptoms. But let me say first that other remedies besides Pulsatilla, having aggravation from eating fatty foods, are Ipecac, Thuja and Carbo veg. Arsenicum and Carbo veg. have aggravation from eating ice-cream, and Nux vomica and Ipecac, from partaking of a mixed diet, or aggravation from eating at night, you may think also of Cincho7ia; for desire for lemonade, of Cyclamen, Sabina and Belladonna; for nausea at the thought or smell of food, particularly if rich or fat, -of Sepia and Colchicum; for vomiting of food long after eating, Kreosote. Bryonia we know produces a catarrh of the stomach with white coated tongue, putrid taste in the mouth and a feeling as of a heavy load in the stomach. It may also be indicated in gastric catarrh brought on by chilling the stomach, although it is more suitable when the trouble has been brought on by the heat of summer weather. Bryonia usually, however, has constipation as an accompanying symp- tom, or if it has diarrhoea, it has not this yellowish-green or watery stool. Instead of this, the stools are papescent and have a putrid or old cheese odor. Nux vomica resembles Pulsatilla. Both are serviceable in catarrh of the stomach arising from overeating or from a mixed diet. Espe- cially is Nux indicated after indulgence in alcoholic drink. Dryness of the mouth with little or no thirst and uncomfortable feeling about the stomach, are also found under Nux vomica. The bowels are con- stipated. While heartburn is characteristic of Pulsatilla, water brash is characteristic of Nux vomica; of course this last statement is only comparatively speaking. Antimonium crudum resembles Pulsatilla, but the tongue under this remedy is coated white as though it had been whitewashed. Vomiting predominates over the other symptoms. A slight quantity of food excites nausea and vomiting. It is an excellent remedy in children. Ipecacuanha is a first-class remedy in these gastric catarrhs caused by chilling the stomach with ice-water or by eating pastry, confec- tionery or other indigestible substances. Usually the tongue is clean. It seldom has the thick coating belonging to Pulsatilla or Antimo- nium crudum. Nausea predominates over every other symptom. Arsenicum is complementary to Pulsatilla when gastric catarrh arises from chilling the stomach with ice-cream or ice-water. PULSATILLA. 329 I mentioned for Pulsatilla, the sensation as of a stone in the epigas- trium. You will find a similar symptom under Abies nigra, which has been successfully used in gastric troubles when the patient experiences after eating, a sensation as of a hard-boiled egg in the stomach. In symptoms of the bowels you may use Pulsatilla in constipation occurring in pregnant women or following the abuse of Cinchona and its preparations. The stools are large. You may also use it for diar- rhoea when the stools are of a greenish-yellow or of a changeable color. It is usually caused by partaking of a mixed diet late the night; before. The patient is worse after midnight. .——' Here you should compare Iris versicolor, which is one of the best remedies we have for cholera morbus, coming preferably at two or three o'clock in the morning, with vomiting of food and sour and bilious matters, and purging at the same time. It differs from Veratrum alburn in the absence of coldness and symptoms of collapse. In cystitis or catarrh of the bladder we find Pulsatilla indicated when there is frequent urging to urinate from pressure on the bladder as if the bladder were too full. There is pain in the urethra. The urine itself is often turbid from the admixture of mucus. Clinically, we have not found Pulsatilla a first-class remedy in cystitis, but w7e have found it almost always the remedy in cystic symptoms accompanying pregnancy. It yields to Cantharis, Equisetum and Dulcamara in cys- titis. Gonorrhoea calls for Pulsatilla when the discharge is thick, bland and yellowish or yellowish-green. There are usually pains in the groins when this drug is indicated, and-1 have noticed, too, going across the hypogastrium from side to side. That symptom has sometimes been produced by Pulsatilla. After giving it a few times in these cases, the patient returns, complaining of this aching across the stomach. This symptom occurring thus, calls for the lengthening of the intervals between the doses, or else for its stoppage altogether. In suppression of gonorrhoea, Pulsatilla is indicated if orchitis, or rather epididymitis, ensues. The testicle is retracted. It is enlarged, very sensitive to the touch and dark red. There are sharp dragging pains following the course of the spermatic cord. Unless some other symptoms contraindicate it, Pulsatilla will restore the discharge and relieve the distressing pain, but the patient must be kept quiet and the scrotum must be supported in a suspensory. In some cases I have 33© A CLINICAL MATERIA MEDICA. used hot water locally as an adjuvant. While it seems to increase the swelling, it relieves the pain. In some cases there appears to be an absence of symptoms of a sub- jective character. All you can observe is this, the testicle is swollen and exquisitely sore to the touch. The gonorrhoeal discharge has almost if not entirely ceased. In these cases Hamamelis is your remedy. Clematis is an excellent remedy for gonorrhoeal orchitis when the testicle is indurated and is as hard as a stone. Rhododendron is also a useful remedy when the orchitis becomes chronic and the testicle is indurated exactly as under Clematis. Under Rhododendron, however, the testicle tends to atrophy. There is also a feeling in the gland as if it were being crushed. In induration of the testicle you may compare, at your leisure, Conium, Arnica, Staphisagria, Spongia, Arum, besides the remedies already mentioned. You may give Oxalic acid when there are ter- rible neuralgic pains in the spermatic cords, worse from the slightest motion. Mercurius is called for when the glands are swollen, and when what little discharge remains is greenish, and when there is phimosis. Pulsatilla is of use in enlargement of the prostate. It is indicated by the mechanical symptom, faeces, when they escape, are small and flat. Hydrocele, especially the congenital form, may yield to Pulsatilla. Next let us study Pulsatilla in its relations to the synovial mem- branes. Pulsatilla has not an affinity for the true serous membranes, as we found under Aconite and Bryonia, but it acts on the synovial sacs, which are slightly different from the pure serous membranes. Pulsa- tilla you find indicated in rheumatism of the joints, and in gouty, gon- orrhoeal and traumatic synovitis. The joint is, of course, swollen, and the pains are of a sharp stinging character, and are accompanied by a feeling of soreness or of subcutaneous ulceration about the affected joint. The pains in these joint inflammations are usually erratic, now here and now there. The tearing pains in the joint force the patient to move the affected part. Pressure relieves. These tearing pains often extend down the limb, and are accompanied by jerking, probably through irritation of the muscular nerves, and are relieved by slowly moving about. I dwell upon these pains because they so frequently call for Pulsatilla. They are usually worse from warmth, and are re- lieved by cold. They are worse in the evening. PULSATILLA. 331 Pulsatilla rivals Apis in synovitis, but the latter drug has more effusion than the former, and is indicated when there is a great deal of oedema about the joint. In rheumatism with erratic pains, you may compare Kali bichromicum, Sulphur and Bryonia. Kali bichromicum is called for in gonorrhoeal rheumatism. The pains are better in a warm room. By reason of its action on the digestive organs, Pulsatilla becomes of value in gout or in the gouty diathesis, especially when the trouble has been brought on by indigestion. If the disease persists despite its use, Colchicum follows it well. Now let us consider the action of Pulsatilla on the various organs. We have already studied the mental symptoms of the drug. We have yet to speak of its headaches. These we may summarize as being mostly frontal and supra-orbital. They are generally of uterine, neu- ralgic, rheumatic or gastric origin. They are aggravated by mental exertion and by warmth. They are usually worse in the evening, although the gastric symptoms are w7orse in the morning. When of rheumatic origin, the pains are sharp and seem to go from the head into the face and almost drive the patient mad, so severe are they. In other cases they may be erratic, wandering from one part of the head to the other. In some cases the headache accompanies menstrual suppression. The head is hot. The pain in the head is better in the open air and is often accompanied by nose-bleed. In these headaches you should compare Pulsatilla with the follow- ing: Ranunculus bulbosus, headache on the vertex as if pressed asunder, worse in the evening and on going from cold to warm air and vice versa. Ranunculus sceleratus, gnawing in the vertex in a small spot. Cocculus Indicus, pain in the occiput as if it was opening and shut- ting. Spigelia, sensation as if the head was open along the vertex. Carbo animalis, feeling on the vertex as if pressed asunder; must hold it together. Veratrum album, pressure in the vertex, with pain in stomach, head relieved by pressing the vertex, and aggravated by motion. Menyanthes, compressive headache in vertex and sensation when 332 A CLINICAL MATERIA MEDICA. ascending steps as if a weight pressed on the brain, with cold hands and feet. Phellandrium, pain as from a weight on the top of the head, with aching and burning in the temples and above the eyes, which are con- gested; eyes water; can bear neither light nor sound. The eye symptoms and some of those of the ears have already been considered. We will now proceed with those of the latter organ that still remain. Pulsatilla has long been known as a remedy for otitis ex- terna or inflammation of the external auditory meatus. The pains are very severe, as indeed they must be from the confined nature of the canal, surrounded as it is by bone. The external ear is swollen and red. The pains are usually worse at night. The trouble may end with otorrhoea, which has the character already described. We come next to the action of Pulsatilla on the female organism. It is here that Pulsatilla has won its laurels. We find it indicated in young girls at the age of puberty when the menstrual flow has either not es- tablished itself normally or even not at all. It is especially at this time that you may find this soreness of the apices of the lungs calling for Pulsatilla, and you know well that unless you remove this symptom and establish the menstrual flow, your patient will have some form of phthisis. When the menses are established they are apt to be too late and too scanty. The flow is fitful in its character, now coming on and now stopping, now appearing as dark clotted blood, and again as an almost colorless watery flow. It is preceded by menstrual colic. The pains are of a crampy, griping character, and so severe that the patient can hardly bear them. She almost smothers if the room is closed. She has the Pulsatilla temperament well-marked. Amenorrhcea may call for Pulsatilla, when occurring during the ordinary period of menstru- ation, when it occurs as a result of w7et feet, and when nose-bleed acts vicariously for the menses. In some of these cases a single dose will bring on the menstrual flow, while in others you are obliged to give the drug repeatedly. During pregnancy you may find use for Pulsatilla. Soreness of the uterus and of the abdominal walls may call for it as well as for Hama- melis. Then again it may correct malpositions of the foetus in utero, if the cause is not mechanical. Now I know that in making this statement I am venturing on debatable ground. I do not mean to say that Pulsatilla will make the foetus turn around. But I do mean to say that Pulsatilla will act on the muscular walls of the uterus, and stimulate their growth. PULSATILLA. 333 Sometimes the uterus in its growth during pregnancy develops more on one side than another. Hence there is irregularity in its develop- ment, and the foetus must assume an irregular position. Pulsatilla, by altering the growth of the uterus, permits the foetus to assume its proper position. During labor Pulsatilla is called for when the pains are slow, weak and ineffectual. Then again, we may find the pains spasmodic and irregular, and they may even excite fainting, as in Nux vomica. The patient feels as if smothering, and calls on you to open the windows. Again you may have it called for after labor when the placenta re- mains adherent. In these cases it will not only bring about release of the placenta, but will so tone up the uterus as to avoid post-partum haemorrhage. Cantharis is also useful in this condition. Pulsatilla may also be used for after-pains, the temperament agree- ing. These pains, however, call more frequently for Chamomilla and Xanthoxylum. This last remedy in particular is a good one. Cuprum is a good remedy for severe crampy after-pains in women who have borne many children. Pulsatilla may also be used for scanty or suppressed lochia. It may also be indicated as frequently as Hamamelis in phlegmasia alba dolens, or milk leg The mammary glands are affected by Pulsatilla before, during, and after pregnancy. It is indicated when mechanical irritation, as from carrying school-books, excites the flow of milk. After labor you may still give this remedy when the breast is swollen and painful and the flow of milk scanty or absent, the patient being gloomy and tear- ful. In this connection I may mention several remedies that are more important. I think that Urtica urens is the best remedy for non-ap- pearance of the milk without any other symptoms, there being no apparent reason for the agalactia. Still another remedy is Ricinus communis or castor oil. This has, when used externally, developed milk. It may also be successful when given internally in low potency. Still another remedy is Agnus castus, which is useful when the mind is greatly depressed. Causticum is called for in women of a rheumatic diathesis. The face is usually sallow and the patient gloomy and depressed. Now Pulsatilla, in its relation to diseases of women, has a great 334 A CLINICAL MATERIA MEDICA. many allies. First of all we may mention Actea racemosa or Cimici- fuga. This remedy resembles Pulsatilla because it acts on the uterus. Both remedies favor normal labor. Here Actea is probably the supe- rior of the two. It also resembles Pulsatilla in its action during labor, being indicated for labor-pains, which are very distressing. The symptoms, however, are not intermittent, but rather continuous. As to temperament, we find Actea racemosa differing from Pulsatilla. For instance, it is indicated in a high degree of nervousness, both during labor and out of labor, during w7hich the woman has a horribly apprehensive mood. She has a dread or fear of something about to happen, and this haunts her from day to day. At other times she has a dread of undertaking anything, even ordinary work. Actea race- mosa is also indicated in any deviation from normal in the position of the uterus when there are sharp cutting pains across the hypogastrium from side to side. It is also to be used for ueuralgia reflex from uterine irritation, and that, too, whether it be the nerves of the head, chest or limbs that are involved. Another remedy to be compared with Pulsatilla is Caulophyllum. This is a remedy that we have not had many years, and yet it is so useful that we would not now be able to get along without it. Its main characteristic is intermittency of pains. If they are neuralgic and reflex from uterine disorder, they are intermittent in character. They are usually sharp and crampy, and appear in bladder, groins and lower extremities. During labor Caulophyllum is indicated when there is extreme uterine atony. The pains may be as severe as ever, yet there is apparently no expulsive effort. It is often indicated in nervous women in whom pain seems to be intolerable. The pains are spasmodic and fly about from place to place, now in the groins, then in the abdomen, and next in the chest, but not going in the direction of the normal pains. The patient seems to be exhausted. There is great exhaustion of the whole system. She can scarcely speak at times, so weak is the voice. These are symptoms which call for Caulophyl- lum. It has been used here by most physicians in the low potencies, although all p6tencies may be used. It may also be indicated during the last weeks of pregnancy when the patient suffers from false labor- pains, these consisting of painful bearing-down sensations in the hypo- gastrium. I have known a single dose to stop them after they had lasted for hours. I have next to speak of Helonias dioica, or the false unicorn, one of the order of Liliaceae. This is one of the new remedies, and it is one PULSATILLA. 335 Which has proven itself wrorthy of a place by the side of the well-tried Pulsatilla. It is serviceable in females who are run down as to their nervous system; who are easily fatigued by any work and who com- plain of a tired backache, this tired feeling extending into the limbs. They seem to feel better when they are working than they did when they commenced to work. Now this is not the Rhus tox. condition. It is not due to a limbering up of stiff joints as under the latter remedy. The reason for the symptom is, that some of the languor passes off as the patient continues her labors. The backache is usually situated in the lumbar region just over the site of kidneys, or it may appear lower down and affect the sacral region. Pain, in either of these situations, may accompany uterine disturbances. You will find also that Helonias is useful for suppression of the menses (here it is quite akin to Pulsatilla), when the kidneys are congested. It seems as if the monthly congestion, instead of venting itself as it should through the uterine vessels, has extended to the kidneys, giving rise to albuminuria. The urine is scanty and turbid. Then, again, you find Helonias called for after confinement, when there is a tendency to prolapsus and other malpositions of the uterus. The patient complains of heaviness and dragging in the pelvic region. There is a sensitive- ness which has been expressed as '' consciousness of the existence of a womb." You know that we are not conscious of our internal organs. They move and perform their respective functions without any sensa- tion. The minute your sensations tell you that you have a stomach or liver, that minute you begin to have disease there Accompanying these symptoms of prolapsus and of uterine over-sensitiveness, you will notice too long-lasting lochia, if I may use that term. To be more exact, I should say that there is a sanguineous discharge, which continues for weeks after confinement. I can recall a case which I treated last winter. It was that of a lady who gave birth to a very large child, and suffered afterwards from prolapsus uteri. I gave her several remedies without relieving her, so that at the end of three months she was still uncured. About this time she began to complain of tightness across the chest, with cough and some little bloody sputum. Her mother before her had died of phthisis after giving birth to twins, sol feared serious lung affection. Phosphorus did no good; Nux did no good. I studied up the case more thoroughly. She told me that she felt as though there was a heavy weight over the chest on the sternum and a feeling as though the chest had been gripped in a vise with that sore feeling which follows. This annoyed her when she 336 A CLINICAL MATERIA MEDICA. awakened at night. These chest symptoms were symptoms that had been noticed in the male provers of Helonias. However, I gave that drug, which entirely removed that symptom and the prolapsus. Then, again, with the Helonias you frequently find a tendency to inflamma- tion of the vulva and vagina with formation of pus. You may also use it in ulceration of the cervix uteri. With this there is a leucor- rhcea which has a bad odor, and every little exertion tends to produce a flow of blood. With these symptoms there is almost always per- sistent itching about the genitals with or without the formation of blisters or sores. During labor itself we know little or nothing con- cerning the value of Helonias. A drug to be placed by the side of Helonias is Senecio aureus. This drug causes inflammation of mucous membranes, so that you find it useful when there is tendency to catarrh of the nose, throat and lungs, particularly in women. It is especially suited for nervous, excitable women who suffer much from sleeplessness, traceable to uterine irrita- tion, as from prolapse or flexion of the uterus. The patient suffers from scanty menstruation, and she is apt to be tearful. There is dry teasing cough, with stitching pains in the chest and blood-streaked sputum. The bladder sympathizes with the uterine disease. There is much pain at the neck of the bladder causing burning and tenesmus. After the onset of the menstrual flow the chest and cystic symp- toms become modified or cease, thus showing how intimately they are related to the irregularity in the menstrual effort. Another drug is the Aletris farinosa. This is one of the most bitter substances known. It is closely allied to Senecio and Helonias. In allopathic parlance it is a tonic. It is especially useful in women who in addition to the uterine trouble and leucorrhcea, have extreme con- stipation, great effort being required to effect an evacuation from the bowels. There is great accumulation of frothy saliva. There must also be mentioned for Aletris as a remedy, weakness of digestion; food distresses the patient and lies heavily in the stomach. Cyclamen is very similar to Pulsatilla, They are both suited to chlorotic and anaemic women, and they both have some trouble with the digestion, and intolerance of fatty foods. The menstrual colic and irregularities are almost identical in the two drugs. The same kind of melancholy is common to both. Cyclamen may be distinguished from Pulsatilla by these symptoms: Generally, but not always, there is more thirst with the Cyclamen patient. The Pulsatilla patient feels better in the open air, the Cyclamen does not. The Cyclamen patients suffer PULSATILLA. 337 from a peculiar kind of debility or torpidity, both of mind and body, with languor. They cannot think. They are better when aroused and forced to exercise. When they get up in the morning they feel so heavy and languid that they feel as though they could scarcely go through the day's duties, but when they once get to work they go on tolerably well until night time. That is Cyclamen, and it is very much like Helonias. They suffer, too, from dulness of the senses with flickering before the eyes. You often find this in weak anaemic women. They see various colors before the eyes, very much as under Santonine. Sometimes they have half-sight. The indigestion with which they are troubled has this to characterize it: Formation of flatus which causes colic at night, forcing the patient to get up and walk about till the flatus passes and gives relief. It yet remains for me to speak of Hydrastis Canadensis. This is a remedy which acts even more powerfully on mucous membranes than does Pulsatilla. It causes catarrh of the mucous membranes of the nose, stomach, bowels, bladder, uterus and vagina, the discharge, how- ever, being more acrid than it is under Pulsatilla, and of a thick yellow or bloody appearance; in uterine affections Hydrastis is indicated for prolapsus uteri with ulceration of the cervix. The leucorrhcea is watery at times, and at other times thick, yellow7 and excoriating; this condition being associated with gone, weak feeling at the pit of the stomach and well-marked palpitation of the heart. The tongue is moist, and coated of a dirty yellow color, and takes the imprint of the teeth. The face is sallow, and the eyes are sunken and surrounded by dark rings. The bowels are apt to be constipated, the stools being coated with mucus or intermixed with mucus. Lastly, Lilium tigrinum, which helps in uterine complaints when there are sharp pains across the abdomen from one ilium to the other, but in addition there are marked bearing-down pains, making the pa- tient cross her limbs. She places her hand over the vulva to support the viscera. Pulsatilla cures a fever with these symptoms: The head is hot and the lips are dry. The patient is constantly licking his lips to moisten them, yet he does not wish to drink. It may also be used in intermit- tent fever after the abuse of quinine when thirst appears at two or three o'clock in the afternoon; then comes chill without thirst, and anxiety and oppression from venous congestion of the chest. The patient is sleepy, yet she cannot sleep. Sometimes one hand is hot and the other cold. 22 338 A CLINICAL MATERIA MEDICA. Pulsatilla is indicated in measles. I think that it is often given in the wrong place. It is indicated when the catarrhal symptoms are prominent and we have coryza and profuse lachrymation. The cough is usually dry at night and loose in the day time. The child sits up in bed to cough. It may also be used when there is earache. Do not give Pulsatilla in the beginning when the fever is high. You should begin the case w7ith Aconite or Gelsemium. The eruption may come out to its full extent or it may have a dark appearance. Kali bichromicum is to be used when, instead of simple catarrh of the eyes, you have pustules developed on the cornea. The throat is swollen and pains go from the throat into the ears, the salivary glands are swollen, and there is catarrhal deafness. In neuralgia, Pulsatilla is indicated when the pains are jerking, er- ratic and paroxysmal, and as they continue they become more and more unbearable. Spinal irritation is also an indication for the drug. The neck, and in fact the whole body, feels as stiff as a board. The small of the back feels as if tightly bandaged. There are pains in the sacral region, worse on sitting and when bending backwards. The joints feel weak, as if they would become readily dislocated. Rest relieves these symptoms, hence the patient is better after sleep. In backache, worse from sitting, you may think of Zincum, Kobalt, Sepia and Cannabis Indica. The sleep symptoms of Pulsatilla are very characteristic. The sleep is restless with frequent waking and troubled dreams; on waking the patient is dull and listless. In sleep symptoms Pulsatilla and Nux vomica differ very much. While the former is wide awake and full of ideas in the evening, Nux is sleepy in the evening. The Nux patient awakes at three or four o'clock in the morning feeling rested. Then he goes to sleep again and awakes at the usual time feeling a great deal worse. Cocculus has sleeplessness from pure mental activity. Sickness fol- lows very slight deprivation of sleep. Sulphur has '' slightest noise at night awakens the patient.'' LECTURE XXXIV. RUBIACEiSE. Rubia tinctoria. ( Madder.) Galium. (Also a red dye.) Cinchona. Rubiaceae. -j Ipecacuanha. Coffea. Mitchella. [ Gambier. To-day, gentlemen, we have before us an order of plants from which we derive three very valuable drugs, Cinchona, Ipecacuanha and Coffea. This order also gives us Gambier (a drug not used in our materia medica) and Mitchella, besides several dyes, as the famous Madder and Galium. From the fact that these dyes are red, the order derives its name. The first one on the board is the Cinchona, frequently, although im- properly, called China in our nomenclature. We will now proceed with its consideration: Cinchona. Cinchona. < Cinchona Rubra. Ipecac., Arsenic, Ferrum, Veratrum alb., Carbo veg. Phosphoric ac., Phosphorus, Rhus tox., Bryonia, Pulsatilla. Nux v., Podophyllum, Eupat. perf., Natr. m. Chinin. sulph., Aranea diadema. Lachesis, Cornus florida, Eucalyptus. >Pulsatilla, Arsenic, Ipecac, Veratr. alb. Tabac., Ars., Nux v. Cuprum. Ipecacuanha cephaelis is a small shrub growing in Brazil. It is bitter, acrid and nauseous, and possesses a peculiar odor which, in some, excites sneezing and even asthma. In many cases the conjunctivae are injected, with puffiness under the eyes, profuse coryza and tension over the eyes. Ipecacuanha contains as its active principle a substance called Fmetin, which gives to the drug its property of producing vomiting. It also contains an acid called Ipecacuanhic acid, and a small quantity of a foetid volatile oil. This latter constituent probably has something to do with the action of the drug on the pneumogastric nerve and its con- sequent use in the treatment of asthma. Ipecacuanha is easily studied. It acts upon the nerves (especially the pneumogastric) and mucous membranes. It has been employed by allopathic physicians as an anti- spasmodic in asthma and in pulmonary catarrhs. In the latter class of troubles it is used to provoke vomiting, and, of course, gives temporary relief. Of the mucous membranes, it seems to have a special affinity for those lining the bronchial tubes and alimentary canal. One of the most prominent features of this drug is its property of producing nausea and subsequently vomiting. So prominent is this symptom that you will find it present in almost all the cases in which Ipecacuanha is re- quired. Studied more particularly, Ipecacuanha is found suitable for patients 352 A CLINICAL MATERIA MEDICA. who are easily irritated, full of desires, but know not for what. If a child, the patient cries and screams almost continually. As an adult, he is irritable and morose, holding everything in contempt. Thus you will find Ipecacuanha indicated in headaches. These are of rheumatic origin. The characteristic sensation is a pain as if the head or bones of the head were bruised or crushed, this feeling seeming to go down into the root of the tongue. This headache is accompanied by nausea and vomiting. Ipecacuanha may also be used in unilateral sick headaches with deathly nausea. In these cases the face is usually pale, blue rings surround the eyes, and the expression about the mouth betrays the intensity of the nausea. Now, these symptoms are not so necessarily present in the adult as they are in the child. You see the corners of the child's mouth drawn, and a line which extends from the alae of the nose to the corners of the mouth, giving to the child an expression of nausea, and at once suggesting to your mind such remedies as Ipecacuanha, Antimonium tartaricum and sEthusa cynapium. In that bursting headache of Ipecacuanha compare Veratrum album, which has that bruised feeling here and there in the brain. There is still another drug which has that symptom, and that is Ptelea. The gastric symptoms of Ipecacuanha, in addition to those already mentioned, are such as would call for the exhibition of this drug after indulgence in rich food, as pastry, pork, fruits, candy, ice-cream, etc. Nausea is constant with all complaints; vomiting of bile; vomits just after eating (like Arsenic); vomits after eating rich or indigestible food; vomiting of mucus; morning sickness. The tongue is usually clean, which latter symptom differentiates it from Nux, Antimony, etc. Dis- tress in the stomach; it feels relaxed as if hanging down (like Staphisa- gria, Theine, Lobelia, Tabacum). These gastric symptoms which I have just given you for Ipecacuanha should be compared with those of three other remedies, the most im- portant of which is Pulsatilla. You will at once recognize the simi- larities between the two drugs. They are both useful for gastric dis- turbances caused by indulgence in mixed diet, pastry, ice-cream, pork, fatty food, etc. Pulsatilla may be considered the better remedy of the two, when the stomach yet contains the food which disagrees, while Ipecacuanha is better when the stomach is empty and the effects of the indulgence only remain. The best distinction between the two reme- dies, however, lies in the condition of the tongue. In Ipecacuanha, the tongue, as above stated, is clean or only slightly coated, whereas IPECACUANHA. 353 in Pulsatilla the tongue is almost always foul, white or yellow, with a very disagreeable taste in the mouth. Arsenicum must follow or supplant Ipecacuanha when an actual catarrh of the stomach has been produced by indigestible food, espe- cially after sudden chilling of the stomach with ice-cream or ice-water. There are vomiting, burning pains in the stomach, diarrhoea, restless- ness, etc. Antimonium crudum, like Ipecacuanha, is suitable for gastric catarrh, following a mixed diet of pastry, etc. The tongue is thickly coated white as if it had been whitewashed. Ipecacuanha may be indicated when, in the case of children, in- dulgence in rich food has produced convulsions. It may even be useful in the convulsions of teething children, or convulsions following sup- pressed eruptions, cold, etc. They are of the rigid tetanic form. Sometimes the rigidity alternates with flexing of arms and jerking of arms towards each other. Colic may occur, and this is of a griping character. Either the pain is situated about the umbilicus, as though a hand were tightly clutch- ing the intestines; or the colic consists of cutting pains which shoot across the abdomen from left to right. The stools are either green, as in diarrhoea of infants, or they are yellow and liquid, and covered with mucus and blood. Sometimes they have a fermented appearance and look like molasses. That is as good a comparison as I can give you; the stool looks just like molasses when it is frothy. At other times the stools are black from admixture of bile. Some of these diarrhoeas are associated with tenesmus, indicating catarrh of the lining membrane of the bowels. Ipecacuanha you will find frequently indicated in the commencement of cholera infantum. You find present pallor of the face, with the blue rings around the eyes, the fontanelles are still open, showing de- fective nutrition; the child may have nose-bleed with the pale face, it is drowsy, with starting and jerking of the muscles during sleep. The child is subject to frequent attacks of nose-bleed. The condition already simulates that of hydrocephaloid. You must not think be- cause Ipecacuanha is wedded so closely to stomach symptoms, that it cannot be indicated in this reflex cerebral state. You will find nausea and even vomiting usually present. The child eats or drinks and vomits what it has taken almost immediately afterwards. Particularly is Ipecacuanha indicated in these cases as a remedy preceding the ex- 23 354 A CLINICAL MATERIA MEDICA. hibition of Arsenicum. Arsenicum is complementary to Ipecacuanha in these abdominal affections. In some of these cases of gastro-intestinal troubles in children it will be your misfortune to have Ipecacuanha and the other remedies just mentioned to fail. Then it will be well for you to bear in mind the following remedies, which, though infrequently indicated, may prove themselves to be of inestimable value. CEnothera biennis, the evening primrose, common in fields and waste places, is an invaluable remedy in exhausting, watery diarrhoea. It does not act, as has been suggested, as an astringent, by its tannic acid, but is a genuine homoeopathic remedy, producing and curing diarrhoea. The evacuations are without effort, and are accompanied by nervous exhaustion, and even with incipient hydrocephaloid. Gnaphalium causes a watery, offensive morning diarrhoea, which repeats itself often during the day. The provers were children, and well have they portrayed a very common group of cholera infantum symptoms. They had rumbling in the bowels, colicky pains, and were, at the same time, cross and irritable. The urine was scanty, and the appetite and taste were lost. A writer in the Homoeopath used this drug very successfully last summer, and Dr. Hale refers to it in his Therapeutics. Geranium maculatum is also a successful baby's remedy. Dr. Hale devotes eight pages to Geranium and other astringents, dividing their action according to his rule of primary and secondary symptoms, and deducing thence two propositions for use in practice. The provings, brief though they are, help us in the choice of the drug; constant desire to go to stool, with inability for some time to pass any faecal matter, then the bowels move without pain or effort. Mouth dry, tip of tongue burning. Allopaths use it as an astringent. Paullina sorbilis has been suggested for diarrhoea, which is green and profuse, but odorless. Opuntia comes to us recommended by so careful an observer—Dr. Burdick—that, although I have not used it, I do not hesitate to present it anew. Nausea from stomach to bowels; feels as if the bowels were settled down into the lower abdomen (confirmed in adults). In infants we may, perhaps, look to this drug when the lower part of the abdomen is the seat of disease, as this seems to be its characteristic seat of attack. Nuphar luteum causes a yellow diarrhoea, worse in the morning, either with colic or painless. It has been employed for diarrhoea IPECACUANHA. 355 during typhoid, and indeed seems to cause nervous weakness. Whether it will be of service for infants remains to be seen. We should look to it when Gamboge, Chelidonium, etc., fail, and when exhaustion is a prominent attendant. Kali bromatum has been several times given successfully in cholera infantum when there were great prostration, cool surface and symptoms of hydrocephaloid. Compare Cinchona (incipient hydrocephaloid, fol- lowing prolonged or oft-repeated diarrhoeic discharge), Calcarea phos., Carbo veg., Veratrum alburn, Camphor, etc. Another effect of Ipecacuanha, and one which is just as characteristic as its action on the bowels, is its action on the mucous membrane of the respiratory tract. Thus it may be used in coryza. The nose feels as if stuffed up; often there is epitaxis, loss of smell, nausea and some catarrh of the bronchial mucous membrane. You may compare here Allium cepa, which is an excellent remedy for simple nasal catarrh when the nasal secretion is watery and acrid. Lachrymation is mild. There are rough raw feeling in the throat and cough provoked by tickling in the larynx. I may say in qualifying these symptoms of Allium, that although it quickly stops the nasal catarrh, it seems to drive the trouble to the chest. Phosphorus seems to stop this action of Cepa. Euphrasia is very similar to Cepa in nasal catarrh. Here, however, we have excoriating lachrymation and bland nasal discharge. Arsenicum follows Ipecacuanha, in the catarrhs of fat, chubby chil- dren. Affecting prominently, as Ipecacuanha does, the pneumogastric nerves, we would expect it to be useful in affections which involve these nerves, as asthma, in which disease it is indicated when there is a sensation as of constriction of the chest worse from the least motion. The patient coughs and you hear the rattling of mucus in the chest, yet none is expectorated. Especially will you find this kind of asthma calling for Ipecacuanha in stout persons of lax fibre, either adult or child, and who are especially sensitive to a warm moist atmos- phere. Very similar to Ipecacuanha in asthma is Arsenicum, which often follows it well either in catarrhal or nervous asthma. Cuprum is also useful in asthma when the spasmodic element pre- dominates. The face gets blue; there is constriction of the throat; the patient almost goes into convulsions. Another drug closely allied to Ipecacuanha is Lobelia inflata. This 356 A CLINICAL MATERIA MEDICA. has, with the asthma, a weak sensation in the epigastrium, spreading up into the chest, nausea, profuse salivation and a feeling as of a lump in the stomach. ipecacuanha is one of the best remedies we have for capillary bron- chitis of infants, especially if caused by the kind of weather I have described. There is a great accumulation of mucus in the chest. The examining ear hears rales all through the chest, both anteriorly and posteriorly. The cough is spasmodic and usually attended with vomit- ing of phlegm. There may be fever and Ipecacuanha still be indicated. The child may have great difficulty in breathing from the great accu- mulation of mucus in the chest. In such cases, I have used the remedy in all potencies; that is to say, from the third to the twenty thousandth, and I have been well satisfied with its action. When Ipecacuanha is indicated, the stage for giving Aconite has passed, because exudation has begun. If you adhere to the principles of homoeopathy7, you will not give Aconite and Ipecacuanha in alternation. After giving Ipecac- uanha, you will notice that the mucus does not adhere so firmly to the walls of the bronchial tubes, but it becomes less tenacious and is raised more readily. Let me warn you that there are two or three changes which will call for concordant remedies. One of these changes calls for Antimo- nium tartaricum, and that is when the cough grows less and less fre- quent, the quanity of mucus in the chest not diminishing in amount. The infrequency7 of the cough is not a good symptom, although the mother will think so. The chest is so filled with mucus that the child cannot cough. He grows more and more drowsy. In giving Antimonium tartaricum in these cases, give it in frequent doses until the cough increases. Another change calls for Phosphorus, and that is when the inflamma- tory symptoms increase and the substance of the lungs is involved and pneumonia obtains. Then Ipecacuanha ceases to be the remedy. Any one who practices in the colder parts of the country will find these catarrhs frequent, and with Aconite, Ipecacuanha, Antimonium tar- taricum and Phosphorus, he can manage the great majority of his cases. Still other remedies may be needed. In some cases Antimonium tartaricum, though apparently well indicated, fails to control the symp- toms. Then we may have recourse to Sulphur, which produces in the healthy catarrh of the bronchial mucous membrane with loud rales all through the chest, especially in the left lung. Especially is it indi- IPECACUANHA. 357 cated when there is atelectasis. In just such cases I have used Sulphur with success. Another remedy is Terebinthina, which I have used when the child was drowsy and the lungs seemed to be all clogged up. The urine is apt to be scanty and almost dark from the admixture of blood. Terebinthina must be given repeatedly. Still another remedy is Lycopodium, which affects more the right lung. Loud rales are heard all through the affected part. Expectora- tion is yellowish and thick. We may be called upon to give Ipecacuanha frequently in whooping- cough, this by virtue of the spasmodic character of the cough and the action of the drug on the pneumogastric nerve. You will find in addi- tion to the symptoms already mentioned, that there are spasmodic con- vulsive symptoms present. During the cough the child stiffens and becomes rigid (from tonic spasm of the extensor muscles), loses its breath and turns pale or blue in the face. Finally it becomes relaxed and vomits phlegm, which of course relieves. While Ipecacuanha is of excellent service here, you are reminded of two other drugs which are similar. One of these is Cina, which I must ask of you to remember as being somewhat more than a mere worm remedy. This remedy is useful in whooping-cough with the same kind of rigidity that I have described for Ipecacuanha, but there is in addition a clucking sound down the oesophagus as the child goes out of the paroxysm. If in addition to this symptom you also have grinding of the teeth, Cina is certainly a better remedy than Ipecacuanha. Cuprum is the complement of Ipecacuanha in spasmodic affections and in whooping-cough. It is especially indicated in convulsions from worms and during the course of whooping-cough. Spasms of the flexors predominate. In fevers we may use Ipecacuanha, especially in those of an intermit- tent type. As I said in my lecture on Cinchona, it is one of the best drugs to give when your case is completely mixed up. It is particularly indicated when there is a short chill, followed by long fever with nausea and vomiting, especially after the abuse' of Quinine. Ipecacuanha is an excellent drug for haematuria, for haemorrhage from the kidneys when the trouble is attended with nausea, oppression of the chest, hard breathing, and cutting pains in the abdomen. In some cases those who work in Ipecacuanha are affected with a violent inflammation of the conjunctiva. Now this fact led Jousset 358 A CLINICAL MATERIA MEDICA. to apply the drug in the treatment of ophthalmia, and he claims many successes from it in the intense conjunctivitis of scrofulous children. There are tearing pains in and about the eyes and copious lachrymation. Tears gush forth every time the lids are separated. When, however, there is marked keratitis, he prefers Apis. In closing let me give you the Ipecacuanha temperament. Studied as a homoeopathic remedy, you will find it indicated in patients who are full of desires they know not for what. As a child it cries and screams. Children are continually crying and screaming. Adults are irritable and morose, holding everything in contempt. Bismuth seems to hinder the action of Ipecacuanha. Opium increases its action on the bronchial mucous membrane. Coffea Arabicum. Coffea is extensively used as a beverage. Its active principle is Caffeine, which is identical chemically with several others, as Theine, the active principle of tea, and Guaranine, the active principle of Paullinia sorbilis. This Caffeine has been found to retard waste of tissue, as shown by the diminution of the amount of urea excreted. It is more than likely, then, that Caffeine is useful when there is an extra drain on the system, particularly after one has been working hard in hot weather, at which time we have two sources of loss of vitality, one the heat and the other the fatigue from labor. Then a cup of coffee is a very good thing. So, too, it may be used after loss of sleep, when waste is greater than it is after labor. Other things being equal, coffee is not so useful for the young as for the old. Take a man in active business life or one who works hard all day; or an elderly man in whom waste is out of propor- tion to repair, coffee is a remedy to retard the waste. This is the reason, I doubt not, why it is almost instinctive on the part of workmen to fall back on coffee as a beverage, because it gives them what their food will not, a certain amount of strength and an antidote to the wear and tear of labor. What are the effects of Caffeine on the system ? These bear a certain resemblance to Strychnia, for it seems to excite reflex action, and, if persistently given, tetanus as well. It produces sudden starting from the slightest touch of the surface of the body (just like Strychnia), and increased susceptibility to all external impressions. This increased '' excito-motor'' action explains many of its symptoms. Violent emotions, wrhether of pleasure or of pain, produce symptoms. Patients experience sudden joy, and they are at once sick from the ex- COFFEA. 359 citement. They awaken at night without any desire whatever to return to sleep. Coffea also produces an ecstatic state of mind. Here it finds a con- cordant remedy in Cypripedium. Especially is the latter remedy indi- cated in children who awaken at night from sleep, and are unnaturally bright and playful, and evince no desire to go to sleep again. Such symptoms are often preliminary to some brain affection, which the timely use of Cypripedium may avert. Apoplectic congestion may be cured by Coffea, particularly if an ex- cited state of the mind has been the cause of the excessive fulness of the cerebral bloodvessels. So, too, an animated conversation in which the party interested becomes greatly warmed up and has cerebral congestion will call for Coffea. This remedy is only of value, however, in the beginning of these cases, when it is all-sufficient. But if the trouble goes on to effusion (not inflammatory effusion, but effusion of serum by oozing through the distended capillaries), then you must have re- course to Belladonna, Bryonia or some remedy more adapted to effusion than is Coffea. Then, too, we have in Coffea a remedy in eruptive diseases when the eruption keeps the patient awake on account of the excessive itch- ing and burning of the skin ; the patient scratches even until the parts bleed. This symptom is due, in the Coffea case, to the hypersensi- tiveness of the skin. Then, too, we may notice a fear of death allying Coffea with Aconite, this fear of death being usually present with the severe pains. All pain in the Coffea patient is intolerable. He cannot bear even a slight pain, which causes great complaint and crying and whining. Coffea is often indicated in the toothache of children and of nervous people. Sometimes you will be led to give Chamomilla in these cases. You find the mental symptoms indicating that drug, yet it does no good, or it affords but partial relief. You may give Chamomilla when the face is red, when the child cannot bear the least pain and is cross and irritable, and when cold water in the mouth relieves for an instant. But if cold water relieves permanently, Coffea is the remedy. The senses are all too acute under Coffea, not only the sense of touch but that of sight also. Under the stimulating influence of this remedy the patient may see a fine print with a degree of distinctness altogether unnatural. Distant noises seem to be magnified. But there is an opposite to this condition produced by Coffea, and this opposite embraces those symptoms coming from its secondary action 360 A CLINICAL MATERIA MEDICA. or one of depression. We find it acting on the circulation in this way: At first it seems to increase the frequency of the pulse, showing that there is increased action of the heart. Now, it must be remembered that this increased frequency of the pulse is not attended with an in- crease of force, as under Aconite, Bryonia and Baptisia. So you see that the stimulation is not genuine. On the contrary, it weakens the heart muscle. So that after awhile, if this drug be given long enough, or if coffee be indulged in as a beverage to excess, the heart exhibits a ten- dency to dilate. We find Coffea also indicated in diarrhoea, particularly that occurring among housewives; those who have a great deal of care and trouble in the management of the household. Then remember also the use of Coffea for fatigue arising from long journeys, and especially during a heated term. As analogous to Coffea, I would like to mention two or three other drugs that have recently been proved. Piper methysticum, also called Kava-kava and Awa-samoa, is largely used in Polynesia as a beverage. It has also been proved as a medicine. Its effects seem to be something like those of coffee, as it produces at first a feeling of buoyancy or tension, as though every nerve were "strung-up" to its highest pitch. The prover feels that he can work hard without fatigue. If these effects reach their extremes, there is a feeling of mental tension as though the head were large, almost full to bursting. There is dizziness also ; dizziness on closing the eyes or on directing the attention to any object. The vessels of the brain, and particularly those about the base of the brain, feel full, as if ligated (that is the symptom given in the language of the prover). Thus far you see it is something similar to Coffea. But the reverse effects quickly follow the use of Piper, and this reverse is characterized by what we may call brain-fag. The brain feels tired on awakening, as though one had been out late at night and had lost considerable sleep, or as one feels after a hard night's study. There is heavy, dull aching in the head, which is worse from either reading, thinking or any other use of the mind. The mental symp- toms, be they those of excitement or of depression, are relieved by diversion of the mind. Further than this, Piper seems to produce convulsions, and it has cured them. The spasms simulate those of catalepsy. The mind is tired and yields to the least pressure. There is over-sensitiveness to all external impressions. LECTURE XXXVI. SCROPHULARIACEiE. Scrophulariaceae. < Digitalis. Myrica cerifera. Spigelia. Kalmia. Helleborus. es closed. If he attempts to do so he reels and staggers. Mental abnormalities as to shape seem to be characteristic of the Stramonium patient. For instance, he imagines that he is very large, or that one arm is very large. Sometimes he feels as if he w7ere double, or that he had three legs instead of two. These errors as to shape and size in the Stramonium patient remind you of other remedies, particularly of Baptisia, which does not, however, resemble Stramonium in other symptoms in the least. It is to be remembered that both of these remedies have these illusions as to shape. The Baptisia patient feels that he is double, or, what is more character- istic, that his body is scattered about, and he must try to get the pieces together. Other remedies have this symptom; we find it under Petro- leum and Thuja. Under the latter remedy the patient imagines that he is made of glass, and he walks very carefully for fear that he will be broken. During the delirium of the Stramonium patient he frequently attempts to escape, as under all the narcotics. In erysipelas, with involvement of the brain, you may find Stra- monium rather than Belladonna indicated when the disease assumes an adynamic type. The symptoms are very much like those of Rhus tox., but you distinguish it from the latter by the violent cerebral 396 A CLINICAL MATERIA MEDICA. symptoms, the delirium, the restlessness, and the screaming out as if terrified. As in all remedies that irritate the brain, we find grinding of the teeth. We may also find stuttering, which, by the way, has been com- pared to the spasmodic urination of children, when the least excitement will cause them to pass urine in little jets; in a similar way are the words jerked out. Particularly does the patient find it difficult to com- bine vowels with consonants. Another remedy for stuttering or stammering is Bovista. The tongue of the Stramonium patient is red or whitish, and covered with fine red dots, and is dry and parched. In some cases it is swollen and hangs out of the mouth. Stramonium may excite a decided nymphomania, during which the woman, though very chaste when in her normal condition, becomes ex- ceedingly lewd in her songs and speech. She may become very violent in her manner. Often these symptoms occur in women before menstru- ation, in which case Stramonium acts most admirably. The menstrual flow is apt to be very profuse, showing that it is the high degree of congestion that produces the nymphomania. There is a strong odor about these women, reminding one of the odor of animals in the rutting season. I would also like to call your attention to the diarrhoea which Stra- monium cures. The stools are very offensive, smelling almost like car- rion. They are apt to be yellowish. They may or may not be dark, but the offensiveness is the most important symptom. Absence of pain is characteristic of Stramonium excepting in abscess, particularly when it affects the left hip-joint, in which case it may be so intense as to throw the patient into convulsions. The antidote for Stramonium poisoning is lemon juice. Hyoscyamus Niger. Botanically and, in a measure, therapeutically, Hyoscyamus is simi- lar to Belladonna. This interesting drug, though innocuous to some animals, is poisonous to fowls, and has received the name of hen- bane. Hyoscyamus seems to be especially adopted to acute mania, to mania wdthout any evidence of absolute inflammation, to mania which has for its key-note extreme excitation of the sensorium. The patient, under such circumstances, has many flexible notions, all arising from these abnormal impulses. He imagines, for instance, that he is about to be HYOSCYAMUS. 397 poisoned. Possibly he will refuse your medicine, declaring in angry tones that it will poison him. Or he imagines that he is pursued by some demon, or that somebody is trying to take his life. This makes him exceedingly restless. He springs out of bed to get away from his imaginary foe. The senses, too, are disturbed. Objects look too large or else are of a blood-red color. Sometimes objects appear as if they were too distinct; that is, they have an unnatural sharpness of outline. The patient talks of subjects connected with everyday life, jumping from one subject to another pretty much as in Lachesis; all this time the face is not remarkably red, possibly it is only slightly flushed. The pupils are usually dilated, sleep is greatly disturbed, the patient lies awake for hours. As the mania advances he seems to lie in a sort of stupor, and yet it is not a real stupor, because the slightest noise rouses him into all these forms of violent mania. Every little im- pression causes excitement of the sensorium. Accompanying these symptoms we find characteristic debility, this debility showing itself in the great prostration on every attempt to move or walk about, and in paralysis of one or more muscles following the maniacal attacks. As the sensorium becomes more and more depressed he answers ques- tions slowly or else gives irrelevant answers. Sometimes he will be in a stupor from which he can be readily aroused and will answer your questions quite correctly, but he will relapse into the stupid state immediately. With this there is a sort of adynamic condition of the brain resulting from this prolonged over-excitement, and in this con- dition we still find delirium, but the patient is greatly prostrated, stool and urine pass involuntary, the pulse is no longer full and acceler- ated, but it is quick, rapid and without volume, and irregular. Stupor is now complete, sordes appear on the tongue and around the teeth, the lungs are engorged, not from a pneumonic process, but because of hypostatic congestion. Associated with this we have snoring-rattling during breathing. The mouth is opened, the lower jaw dropped, and the patient lies quietly with occasional twitching of groups of muscles. This condition will soon be followed by death unless relief can be ob- tained. At other times we find the delirium returning anew and the symptoms take another form. The patients are silly and laugh in a flippant manner. Sometimes, for hours at a time, they will have a silly, idiotic expression of the face. Again they become exceedingly lascivious, throw the covers off and attempt to uncover the genital region. The abnormal movements accompanying these symptoms are 398 A CLINICAL MATERIA MEDICA. rather angular; they are not at all of the gyratory character significant of the Stramonium. Still another form in which the cerebral symptoms of Hyoscyamus may appear, particularly in women, is jealousy, and also the effects of powerful emotions, as disappointed love, fright and other emotions that are more or less exciting and at the same time depressing. Coming now to inflammation of the brain or meninges, we find Hyoscyamus sometimes indicated when we have present some of the symptoms already enumerated and in addition to these symptoms, relief from shaking the head or sitting with the head bent forward. Here it is exactly opposite to Belladonna. The patient complains of pulsating waves through the head. We have a cough quite characteristic of Hyoscyamus. This cough comes from elongation of the uvula, the result of relaxation or inflam- mation. The uvula hangs down and rests on the root of the tongue, causing irritation and the consequent cough. This cough is worse when lying down, the patient having almost complete relief when sitting up. It is usually worse at night and also after eating and drinking and from talking. There are two or three remedies to be compared with Hyoscyamus here. One of them is Rumex crispus. This is a splendid remedy for tickling cough from an annoying tickling in the supra-sternal fossa. The patient wants to breathe warm air. Anything which disturbs the temperature of the respired air excites the tickling, and hence the cough. The tickling may extend down into the chest and still Rumex be indicated. There is another remedy which has this same symptom, and one which has been confirmed too. It is Mentha piperita. It is inferior to Rumex, however. I have heard it said that eating apples will relieve this kind of cough. Hyoscyamus is also to be considered as a remedy for sleeplessness. It is useful in the sleeplessness of children when they twitch in sleep, cry out and tremble, and awaken frightened. It is also a valuable drug in convulsions. It is one of the most re- liable remedies we have for epileptic convulsions, that is if there is no other remedy indicated. In the Hyoscyamus convulsion we find the patient twitching and jerking. These angular motions that I have described seem to be provoked by eating. Especially is this to be noted in children; the child will wake up from sleep hungry; the face is apt to be of a deep red color, almost on the purple. There are HYOSCYAMUS. 399 also frothing at the mouth and biting of the tongue. These symptoms are almost always followed by profound sleep. In epilepsy compare Cicuta virosa, which has shocks from head down the body; staring; violent convulsions; screaming; red face; limbs greatly distorted; frothing at the mouth; face blue; respiration greatly impeded; trembling before and after the spasm; great weakness after the attacks. We have Hyoscyamus indicated also in chorea. The patients are very weak with tottering gait. They seem to have abnormal impres- sions of distances. They reach for something that .seems to be just within their grasp, when, in reality, it is on the other side of the room. Stramonium is also a remedy to be thought of in chorea, particularly if the brain is affected. The child awakens from sleep with a scream. It sings and laughs without reason. Still another remedy is Veratrum viride, which is particularly indi- cated when there is great congestion in the nervous centres. The pulse is much over-excited. Now let me speak of the fevers of Hyoscyamus. I have already given you the symptoms which would indicate the drug in typhoid fever. We have to see how we may apply it in the treatment of fevers with skin symptoms, as scarlatina. In scarlatina, Hyoscyamus is in- dicated, although not very frequently; but yet it may be called for in cases that have been spoiled by Belladonna. The rash is of a miliary type and is dark or dark red in color. It is rather scanty, too, from partial repercussion. There are also picking at the bed-clothes, crying out in sleep and stupor, all denoting the alarming progress made by the disease. Stramonium is indicated in scarlatina when we have violent symp- toms present, something-like those we have seen in Belladonna. The face is very red, the rash seems to be scattered over the surface, the prostration is excessive, the skin is apt to be very dry and hot without as much of the hot sweat as we have found under Belladonna. If sweat does come it does not relieve. Now let us compare the three remedies, Belladonna, Stramonium and Hyoscyamus, one with the other. In general, we find that Bella- donna causes more congestion or inflammation of the brain, Stramo- nium congestion with more sensorial excitement, and Hyoscyamus more nervous irritation with less congestion and inflammation than either of the others. 400 A CLINICAL MATERIA MEDICA. The type of the delirium in Belladonna is wild; there is a desire to escape; the patient bites and strikes; the face is red and the eyes suffused with violent throbbing of the carotids. He either complains of these hallucinations on closing the eyes or he stares at one point with eyes wide open. Then, too, there is sleepiness with inability to sleep. If there is stupor, it is rather the result of the congestion and inflammation of the brain, and is attended with some symptoms of irritation so that the patient, when aroused, is violent or he alternates between delirium and stupor, there being no evidence of serious blood changes. Hyoscyamus has a similar desire to escape; the patient attempts to bite and strike those about him; he has the same desire to uncover, but he lacks the violent throbbing of the carotids and intensity of the redness of the face and suffusion of the eyes. The Hyoscyamus patient has a particular aversion to light and has especially marked this fear of being poisoned or of being betrayed. Lying quietly in the bed, he suddenly sits up and looks around as if looking for some one whom he expected to see in the room. At a word from the nurse he lies down again and goes off into a sleep. He may expose his sexual organs. His wakefulness is very different from that calling for Bella- donna. He is nervous, whining, crying and twitching. Hyoscyamus is used very extensively in insane asylums for acute non-inflammatory mania. These patients you find always weak; the pulse often lacks volume; they ^either have no appetite whatever or else an enormous appetite. Eating is at once followed by an aggrava- tion of the symptoms. Allopathic physicians use very largely the alkaloid Hyoscyamia. This is very similar to Kali bromatum, having the power of exciting the sensorium without inflaming the brain. Thus we find Kali bromatum indicated in the acute mania of children when they arouse from sleep with screams and imagine that some one is going to hurt them. The patient may also have the insane impres- sion that he is to be murdered or that his honor is at stake, or that those in his house dislike him and intend to hurt him. Hyoscyamus is particularly indicated in these cases if they are puer- peral in their origin. We also find these symptoms of Hyoscyamus in typhoid fevers. The tendency, you will see, is to a low type of disease; it is a more adynamic remedy than Belladonna. Belladonna may be indicated in the beginning of the disease when there is the wild and furious delirium. Hyoscyamus comes in later when the stupor becomes more marked; when the patient picks at the HYOSCYAMUS. 401 bed-clothes or at his fingers in a somnolent sort of way and occasionally he will reach out as if grasping for something in the air. You will find the tongue, in such cases, dry and red; speech, of course, is diffi- cult; and, as the case progresses, we have the sordes on the teeth with involuntary stool and urine and dropping of the lower jaw. I would like to say here, by way of caution, that although a case for Hyoscya- mus is clearly made out by these symptoms, yet it does not always act. I cannot tell you why. I can see no cause except that the drug does not act deep enough. In such cases, I usually look up Lachesis, Lyco- podium, Muriatic acid and Arsenicum. Stramonium differs from Belladonna and Hyoscyamus. The patient sees objects which seem to rise in every corner of the room and move towards him. He has a mania for light and company, which is just the opposite to Belladonna, is excessively loquacious and laughs, sings, swears and prays almost in the same breath. The desire to escape is present; there is sudden spasmodic lifting of the head from the pillow and then dropping it again; he awakens from sleep in fright and terror, not knowing those around him; the motions that he makes are quite graceful and easy, although they may be violent. At times, the body is bathed in a hot sweat which does not give any relief to the patient. The desire to uncover is similar to that of Hyoscyamus, but it is more an uncorering of the whole body rather than of the sexual organs. The tongue is often soft, taking the imprint of the teeth; screaming in sleep, often with hiccough; the face is usually bright red, but not as deeply congested as in Belladonna. 26 LECTURE XL. TABACUM, DULCAMARA, CAPSICUM AND GLONOIN. Tabacum. Tabacum contains several active ingredients, the most important of which is Nicotine. Ever since smoking was an " art," attempts have been [made to get rid of this Nicotine. Every one acknowledges that it has a'serious effect on the body. There are three groups of symptoms which may follow the use of tobacco. The primary symptoms are the well-known gastric symptoms, nausea and vomiting, with the most horrible sickness. The patient is deathly pale, does not care whether he lives'or dies. Sometimes cold sweat breaks out on the body. The secondary effects are more remote, coming months or even years after using the weed, and these are dyspepsia, and also some symptoms of the heart. These symptoms of the heart I would have you remember. If they are not caused by tobacco, Tabacum will be a very valuable remedy in their cure. I refer especially to dilated heart when these symptoms are present: There are frequent pallor, with lividity of the face; diar- rhoea, alternating with constipation; palpitation when lying on the left side; muscae volitantes, tinnitus aurium and dry cough, which is cardiac in its origin; paroxysms of suffocation, with tightness across the upper part of the chest; feeble and irregular pulse; pains like those of angina pectoris shoot from the heart down the left arm or up into the neck, and involve different plexuses of nerves; the extremities are cold and cov- ered with a clammy sweat. Another symptom that may come as a secondary symptom of tobacco is neuralgia of the face. This symp- tom, when thus caused, is curable by Sepia, as is also the dyspepsia. Impotence also follows tobacco, and yields often to Lycopodium. The tertiary effects of tobacco include apoplexy. Tobacco, in its effect on the gastric organs, very much resembles Hydrocyanic acid, Veratrum and Camphor. For instance, we find it indicated in cholera, when the nausea and cold sweat persist after Veratrum, Secale or Camphor has stopped the diarrhoea. This nausea is [accompanied by burning heat about the abdomen, the rest of the body being cold. The patient persists in uncovering the abdomen. DULCAMARA. 403 I would remark here that this kind of sickness suggests Tabacum in renal colic or in strangulated hernia. There are this deathly nausea and sickness, with slimy stool, from irritation of the bowels. The resemblance to Hydrocyanic acid is in asphyxia. The latter drug acts upon the medulla, and, hence, upon the heart through the pneumo- gastric nerves. Consequently, the symptoms you would expect it to\ produce are those of the heart and lungs. We find it producing con- vulsions, with drawing at the nape of the neck from irritation at the base of the brain. Along with this, respiration is irregular or gasping, * and there is great distress about the heart, with repeated weak '' spells '' and coldness and blueness of the surface of the body. It is well to re- / member this fact in uraemic convulsions when the medulla is affected./ Hydrocyanic acid is then our only hope. J Tabacum is used as an antidote to the bad effects of Cicuta virosa. The primary effects of tobacco are generally relieved by Ipecac. Nux vomica is indicated for the bad taste in the mouth and the head- ache worse in the morning from excessive smoking. It is said that Plantago major produces a distaste for tobacco. I have seen one or tw7o patients who supposed "they had a dislike to tobacco after taking it. Dulcamara. Dulcamara, or the "bitter-sweet," contains a small quantity of Sola- nine, a much smaller quantity, in fact, than any other member of the group. The tender leaves and twigs have been used for the prepara- tion of the tincture. There have been accounts of poisoning from the berries of the Dulcamara. The symptoms thus produced are hard griping pains in the bowels, followed by unconsciousness and spasms. These latter are tetanic, and are accompanied by hot, dry skin, trismus, loud rattling breathing, and, in one case, death. The ordinary symptoms produced by the drug are not so severe. We find as the very central point around which all the other symp- toms of the drug group, this one: Aggravation from cold, damp weather. or from changes from hot to cold'weather, especially if these changes a7e"suddenT Thus we find Dulcamara useful in rheumatism made worse by sudden changes in the weather; twitching of the muscles of the eyelids or mouth whenever the weather becomes damp; dry coryza, sore throat, with stiffness of the neck; colic from cold, especially with diarrhoea at night; earache, when it returns with every such change in weather. 404 A CLINICAL MATERIA MEDICA. Dulcamara has a marked influence on the nervous system; bat here again its use in practice is often based on the above aggravation. We have the tongue paralyzed in damp weather, with impaired speech; hyper- aemia of the spinal cord with the paretic state belonging to that disease when caused by lying on damp, cold ground, and intensified by every return of damp weather. It is also indicated in paralysis of the bladder aggravated by damp weather. It is also of use in incipient paralysis of the lungs in old people, espe- cially if the symptoms are aggravated by change in the weather. Dulcamara has a specific influence on the lining membrane of the bladder, causing catarrh of that organ. The urine is very offensive, and is loaded with mucus. It also exerts a marked action on the skin. Thus, it develops a bright red eruption on the surface of the body. Here and there there will be large wheals, which may be white or red, and along with these there is usually burning and itching. It is indicated in urticaria traceable to gastric disorder when there is relief from cold air. The complement of Dulcamara is Baryta carb. This has aggravation in cold weather, especially in scrofulous children. Capsicum Annuum. Capsicum possesses few, if any, of the narcotic properties of the Solan- aceae, but it has, highly marked, the irritating properties of the group. It takes but little of the drug to produce this irritation. Cap- sicum is eliminated from the body through the kidneys, producing strangury with burning when passing water. This drug acts best in persons of lax fibre, rather stout in build, who do not respond readily to medicine because they are of lax fibre, and also because of impaired digestion. The Capsicum patient has weak digestion or weak stomach, hence the whole man is weak. Such patients are irritable and get angry without any cause. This is true of either adults or children. They are worse from the least draft of air, though this air be warm. They are clumsy in their motions. They are subject to chills and fever. The chill commences in the back. Although the patient is thirsty, yet drinking causes shivering. The Capsicum patient is subject to catarrhal asthma with red face and well-marked sibilant rales. He coughs, and a successful cough raises phlegm, which relieves the asthma. GLONOIN. 405 Capsicum has a symptom of the chest not often met with in practice, and that is very offensive breath during the cough. It also has a well-marked action on the ear, especially on the middle ear. It is of use in rupture of the membrana tympani from disease when there is soreness or inflammation of the mastoid process of the temporal bone. For abscess of the mastoid process the preferable remedies are Aurum and Nitric acid. For chronic suppuration of the middle ear you may think of Silicea. Capsicum is of importance in diseases of the throat. It is indicated in diphtheria or in gangrene of the throat when there are burning blisters in the roof of the mouth and when there is an odor from the mouth like that of carrion. The throat feels constricted as if spas- modically closed. The patient is worse when not swallowing. In extreme cases the patient becomes greatly prostrated. The most similar remedy here is Cantharis. Capsicum is also indicated in elongation of the uvula. It may be used both externally and internally. In dysentery it is indicated when the stools are frequent but small and attended with violent tenesmus and burning in both rectum and bladder. The stools are bloody and slimy and contain shaggy pieces. There is thirst, and yet drinking causes shuddering. Glonoin.* f Blood. Glonoin. < Trauma. [ Convulsions. Glonoin is nitro-glycerine. It is a very easy drug to study. Its main point of attack is the blood. It does not, however, affect the quality of the fluid so much as it does its circulation. The key-note to the whole symptomatology of the drug is expressed in this one sen- tence: "A tendency to sudden and violent irregularities of the circula- tion." With that for our foundation we can easily work out the other symptoms. Glonoin is a drug which acts very quickly and very vio- lently. The symptoms which are traceable to the irregularities in the circulation are these: Very characteristic, indeed, is a throbbing head- ache. The pain may be in the whole head, or it may be in the fore- * Glonoin was considered in this part of the course of lectures on account of its symptomatic resemblance to Belladonna. 406 A CLINICAL MATERIA MEDICA. head, vertex, occiput or any one part of the head. This throbbing is not a mere sensation; it is an actual fact. It really seems that the blood- vessels would burst, so violent is the action of the drug. The throb- bing is synchronous with every impulse of the heart. The blood seems to surge in one great current up the spine and into the head. The bloodvessels externally become distended. The external jugulars look like two tortuous cords, the carotids throb violently and are hard, tense and unyielding to pressure. The face is deep red. This throbbing is either associated with dull, distressing aching or with sharp, violent pains. We find Glonoin applicable to sunstroke, indicated either by the symptoms already mentioned, or by symptoms which show that the prolonged congestion has produced depressing effects upon the brain. The face becomes rather pale, the pulse, which was at first full, soft and feeble, and respiration labored. There is not so very much press- ure about the chest as about the medulla oblongata, thus interfering with the nerves of respiration. The eyes are often fixed. The patient may even be unconscious. Glonoin, then, we find to be our best remedy for the effects of heat, whether the trouble arises from the direct rays of the sun, from hot weather or from working in the in- tense heat of a furnace, as in the case of foundrymen and machinists. These effects of the sun or heat are not confined to the head alone, but may involve the whole body. Thus we note oppression of breathing, with palpitation of the heart and nausea and vomiting, the tongue being white. This nausea is not gastric in origin, but cerebral, as under Rhus tox., Belladonna and Apomorphine. The appetite is gone; there is no desire for food; there is a horrible sunken feeling in the epigastrium, and often, too, diarrhoea. All these symptoms may and do call for Glonoin. Still other effects of this congestion are found in the eye. The eyes feel as if too large and protrude as though bursting out of the head. Glonoin is indicated in eye diseases arising from exposure to very bright light, as in the case of one obliged to work at a desk beneath a hot, bright light, as a bright Argand burner. If you should examine such an eye with the ophthalmoscope, you will find the bloodvessels of the retina distended or, in extreme cases, apoplexy of the retina. Still other effects of the increased blood pressure under Glonoin may be noticed in the symptoms of the mouth. For instance, there is difficulty in conversation from diminished power of the tongue, this GLONOIN. 407 being the result of pressure on the brain. Wine aggravates all these symptoms. Another effect of the cerebral congestion is convulsions. Glonoin is an admirable remedy for the convulsions coming on during labor, puerperal convulsions. The face is bright red and puffed, the pulse full and hard and the urine albuminous. The patient froths at the mouth; she is unconscious. The hands are clenched, the thumbs being in the palms of the hands. At other times the hands are stretched out as under Secale, and the patient is unconscious. I think that Glonoin is one of the best remedies we have for the congestive form of puerperal convulsions, that form which is announced by rush of blood to the head, especially if there is albuminuria. It is also in- valuable in congestion to the head from suppressed menses. The mental symptoms traceable to this congestion are syncope or sudden fainting, the face being pale or often livid, black spots before the eyes, sudden onset of unconsciousness, well-known streets seem strange to the patient. This last symptom is one decidedly dangerous. Suppose a person who is subject to apoplectic congestion, is suddenly seized in the streets with one of these attacks and does not know where he is, then Glonoin is the remedy for him. Another remedy for this loss of location is Petroleum. Sometimes the congestion is so great as to make the patient frantic. He tries to escape, to jump out of the window. Glonoin is also useful for the bad effects of fear. I mentioned that briefly when speaking of Opium. There is horrible apprehension and also sometimes the fear of being poisoned. This last symptom places it alongside of Hyoscya- mus, Rhus tox., Bromide of Potassium and Baptisia. Another use of Glonoin is its application to trauma. It has been found an excellent remedy for pains and other abnormal sensations, following late after local injuries. Long after the reception of an in- jury, the part pains or feels sore, or an old scar breaks out again; then Glonoin seems to relieve. It is necessary for you to remember the distinctions between Bella- donna and Glonoin, because they meet in the congestions and inflam- mations of the brain with children and old persons. They divide the honors in these diseases, because each has a number of confirmed cures. We have the cri e7icephalique in Glonoin which is not so marked under Belladonna, so it would seem that Glonoin would suit a worse case than would Belladonna. The symptoms which would help you are these: First, Glonoin; the head symptoms are worse by bending the 408 A CLINICAL MATERIA MEDICA. head backwards; worse in damp weather; worse from the application of cold water, even causing spasms; better from uncovering; better in the open air; sometimes the patient is obliged to get up and walk about despite the soreness that jarring causes. A very marked symptom which anticipates puerperal convulsions and which is an early symptom in congestion of the brain from suppressed menses and a prominent symptom in the bad effects of the heat of the sun, is a feeling as if the head was enormously large. The head seems as if it was expanding. Although that symptom is found under Belladonna, it is not so char- acteristic of that drug as of Glonoin. Now Belladonna has relief from bending backwards, from sitting up with the head quiet. Belladonna usually has relief from covering the head, while Glonoin has relief from uncovering, although the latter symptom is of less importance than the others. The best antidote to Glonoin that I know of, is Aconite. LECTURE XLI. LYCOPODIUM CLAVATUM. Lycopodium clavatum. Constitution. Blood. a. Fevers. b. Ebullitions; pulse. c. Varices. d. Typhoid. e. Scarlatina. f. Diphtheria. Liver. Dropsy. Catarrhs. Kidneys. Lycopodium or club moss has long been used in legerdemain and also in pyrotechnic displays for the production of artificial lightning. In legerdemain it is used as a coating to the hand, after which that member may be dipped in water and removed from thence perfectly dry. As a medicine, it was considered wholly inert by members of the allopathic school of practice, and was used only as a drying powder by nurses. In the experience of some it was found that quite severe symp- toms followed the use of this powder. Others, on the contrary, used it for months and years, and positively declared it to be inert. Now why was this ? The Cryptogamia, unlike other plants, have, instead of seeds, spores, which are sometimes arranged under the leaves, as in the case of Lycopodium. Now these spores have a hard, shell-like covering, within which we find a small quantity of oily substance, which is the active part of the spore. As long as the Lycopodium used consisted of unbroken spores it was inert; when, however, these were ruptured, it became active and symptoms followed its local applica- tion. In the preparation of Lycopodium, great care should be taken to see that all the spores are broken. When thus prepared, we have in it a truly valuable medicine which Hahnemann proved for us, and one, too, which we need in practice almost every day. I love to extol 410 A CLINICAL MATERIA MEDICA. the virtues of this remarkable drug, for Hahnemann with his infallible Law, rescued it from its ignominious use as an infant powder, and ele- vated it to the highest rank among the antipsorics. In order that you may understand the symptomatology of the drug, I have arranged the schema which you see before you on the board. First of all, we will study the constitution—that is to say, the general character of the drug. We find Lycopodium indicated most frequently in emaciated persons who are muscularly weak; the mind, however, is well developed. Particularly is this noticeable in children. There is a predisposition to liver troubles, and also to affections of the lungs; the face is often pale and sallow; the eyes being sunken and surrounded with dark bluish circles. Often, too, the face is furrowed with creases and wrinkles, indicating deep-seated disease. The face readily flushes, the cheeks become red. This is often so in the evening and after eating. As to temperament, the Lycopodium patient is rather impatient and irritable, easily getting angry. At other times, sad- ness or tearfulness is well marked. When sick, such patients are apt to become domineering and rather imperious in manner; or to consider themselves of great importance and those about them of no importance, so they order others about with an angry vehement manner. As to the intellectual part of the mind, we find the memory always weak. Thus we find the drug often indicated when there are frequent mistakes in speech. The patient forgets words or syl- lables. The changes made in the blood by Lycopodium are not numerous. In febrile states we sometimes find it indicated by chill coming at three or four o'clock every or every other afternoon; this chill being followed by sweat without intervening heat; or the case may be characterized by chill coming at this hour and sour vomiting. There may or may not be heat. The pulse in Lycopodium is not very characteristic. In the provings the pulse is changed very little, except that it is slightly increased in frequency towards evening. Next, I have to notice varicose veins. Lycopodium, by reason of its action on the liver, tends to produce swelling or enlargement of the veins, particularly those which are more or less imperfectly sup- plied with valves; so we have varices characteristic of Lycopodium; varices in the legs, particularly the right; varices of the genital organs; the labia are swollen by varicose veins; this latter condition LYCOPODIUM. 411 occurring during pregnancy, being a symptom which calls for Lyco- podium . So, too, we often find naevi modified by Lycopodium. Now, do not suppose that every nsevus is curable by medicine, for such is not the case. It is, however, your duty to cure them by medicine when you can. For this purpose, Lycopodium is one of the remedies. Still another remedy, and one, too, which is better than any other, and has also produced naevi, is Fluoric acid. So, too, carrying out a similar line of sy7mptoms, you will find Lyco- podium indicated in bleeding piles, piles which contain an immense amount of blood, a far greater quantity of blood than the size of the vein involved would warrant; also in piles which do not mature, but which, from partial absorption of their contents, remain as hard bluish lumps. Then, again, in erectile tumors which have now an increase and then a decrease of the amount of blood in them, Lycopodium may be use- ful. Lycopodium must have some effect on the blood or on the nervous system because of its general use in typhoid states. It is not in the beginning of typhoid fevers that it becomes the remedy, but it is wrhen the disease has gone on, despite your treatment, to that state in which the symptoms are very alarming. The symptoms which guide you to the selection of the drug are these: First, in regular typhoid fever it is indicated on or about the fourteenth day of the fully-developed fever, when the rash belonging to the fully-developed disease does not appear and the patient sinks into an unconscious state, with muttering deli- rium, picking at the bed-clothes, distended abdomen, with great rumb- ling of flatus, constipation, sudden jerking of the limbs here and there, involuntary urination or retention of urine; if the urine is passed in bed, it leaves a reddish sandy deposit in the clothing. These are some of the indications for Lycopodium in typhoid fevers. They are very similar to those calling for Calcarea ostrearum. Cal- carea ostrearum has been found to be the remedy in this stage of typhoid fever when the rash does not appear. But Calcarea may have either constipation or diarrhoea. Lycopodium always requires constipation. Calcarea has more hallucinations. The patient sees visions when he closes his eyes; he cannot sleep; although he may be fully conscious, yet he is continually frightened by some imaginary object. In such cases Calcarea develops the rash and brings the patient out of this precarious state. 412 A CLINICAL MATERIA MEDICA. We may have Lycopodium indicated in worse conditions than this; when by reason of the prolonged temperature of the typhoid we have impending paralysis of the brain, it here becomes a leading remedy. The patient lies in a stupor; the eyes do not react to light, and have a fishy look; the lower jaw is dropped and hangs down; the breathing is snoring and rattling; you can hear mucus rattle as air goes in and out of the lungs; the urine is either passed involuntarily or is sup- pressed. The pulse is intermittent and rapid. In these cases Lyco- podium should be given, and it will save the patient if any remedy can. In these typhoid conditions we have an indication for Lycopodium in the tongue. The tongue seems swollen and the patient cannot pro- trude it, or when the patient does put it out, it rolls from side to side like a pendulum. Almost always, too, the tongue is dry and has blis- ters on it. These are symptoms enough to warrant you in the choice of Lycopodium. In scarlatina, Lycopodium is not indicated by its power to produce an eruption and fever similar to those of scarlatina; it is called for, rather, in those cases which do not take a normal course, but which go on to a fatal issue by reason of the constitution. You are guided here by the typhoid symptoms just mentioned, and also by another symp- tom which anticipates these and leads you to Lycopodium long before such serious symptoms appear. I refer to the condition of the child after sleep. The child wakens cross and irritable, kicking the clothes off and striking every one about it. Although this symptom may seem insignificant, it is not so by any means. Here it resembles Cu- prum, Belladonna, Stramonium and Zincum, all of which remedies have arousing from sleep as if frightened. The element of irritability and the absence of symptoms characteristic of the other drugs lead you to Lycopodium. We may make another use of this symptom. Sometimes children have a disease called " gravel," in which lithic acid is passed in suffi- ciently large quantity in the urine as to cause pain on passing water. They awake from sleep screaming out with pain and kicking at all around them. Here Lycopodium is indicated by both the subjective and the objective symptoms. Often, too, when Lycopodium is indicated in scarlatina, you will find that one or the other parotid gland is inflamed and discharging purulent matter. Probably the very best remedy in the materia medica for parotitis LYCOPODIUM. 413 accompanying scarlatina is Rhus tox. The next best is Calcarea ostre- arum, and next to that Lycopodium. Lachesis is only indicated when the swelling is purplish and the pus is not laudable but thin, excoriat- ing and ichorous. In diphtheria, Lycopodium is to be thought of when the diphtheritic deposit is most copious on the right side of the throat, with a tendency to spread towards the left. There is a constant desire to swallow, amounting almost to spasm of the throat, with violent stinging pains. The patient is worse from swallowing drinks, especially cold drinks. You often find the symptoms aggravated from four to eight p. m. Generally, when Lycopodium is the remedy in either scarlatina or diphtheria, the nose is invaded by the disease. The patient cannot breathe through his nose. The tonsils are very much swollen, as is also the tongue, so that he is obliged to open the mouth and protrude the tongue in order to get breath. Sometimes, after you have given Lachesis, the membrane goes to the right side. Then Lycopodium comes in as a substitute. Next we come to the action of Lycopodium on the liver. Lycopo- dium acts very strongly on this organ, producing quite a number of symptoms. First, beginning with the mouth, we find the tongue coated, sour or, exceptionally, putrid taste in the morning on arising; violent hunger, almost amounting to canine hunger; a few mouthfuls of food seem to produce fulsomeness, as though the patient were "full up to the throat," quickly followed by hunger again; distress in the stomach immediately after eating, not some little time after, like Nux vomica; cannot bear the pressure of the clothing about the waist, here being somewhat like Lachesis; but it is distinguished from Lachesis in that the latter has the sensitiveness all the time, but Lycopodium only after a meal. The region of the liver is very sensitive to touch. Sometimes there is a feeling of tension there, and this feeling of tension is a subjec- tive symptom which leads you to the choice of Lycopodium in chronic hepatitis when abscesses have formed. The diaphragm is very apt to be affected in this state. There is a feeling as though a cord were tied around the waist. There is marked collection of flatus. Possibly that is the reason why a small quantity of food fills the patient up. This flatulence tends upwards rather than downwards; rumbling of wind in the splenic flexure of the colon, with distension of that portion of the intestinal tract. {Momordica also has this.) There is great fermentation in the intestines, this being followed by discharge of flatus, and even by diarrhoea. The bowels are usually constipated, however, with in- 414 A CLINICAL MATERIA MEDICA. effectual urging to stool. After stool there is a feeling as of a great quantity remaining unpassed. Now these symptoms, especially if associated with ascites, will lead you to the choice of Lycopodium in that disease known as cirrhosis of the liver. Lycopodium, in these gastric and hepatic symptoms, has many ana- logues, one of which is Nux vomica. Nux may be distinguished from it by the following: Although Nux vomica has sour taste in the mouth, aggravation in the morning and fulness after eating, yet the immediate distress is more prominent under Lycopodium. In the accumulation of flatus, of the two remedies Nux has more pressure downwards, giving frequent urging to stool and pressure on the bladder. Both remedies have prominently constipation, with ineffectual urging to stool. The difference between the two remedies is this: Nux vomica has this in- effectual urging from its fitful action; under Lycopodium it arises from contraction of the sphincter ani. Sulphur is also similar in the accumulation of flatus and in the sour and bitter taste; but the characteristic place for the accumulation of flatus in Sulphur is in the sigmoid flexure, and is referred by the patient to the left groin. Raphanus is also to be thought of in cases with accumulation and retention of flatus. Dr. James B. Bell, of Mass., one of our most emi- nent surgeons, performed an operation on the abdomen. The patient was decidedly tympanitic, and yet he passed no flatus whatever, although the bowels moved. That symptom is under Raphanus. Dr. Bell gave that remedy, and the patient recovered. Next we come to the dropsies curable by Lycopodium. We find the remedy indicated in dropsies, particularly in the lower half of the body. The upper part of the body is emaciated, the muscles of the arms and chest are shrunken, the abdomen is distended, and the legs swollen and covered with ulcers, from which serum continually oozes. Now, there are three remedies which may be given when ulcers form on the legs in dropsy. They are Rhus tox., Lycopodium and Arsenic. The cause of the dropsy indicating Lycopodium is liver disease. It has also been used successfully for hydropericardium in heart disease after the failure of Arsenic. We next come to the catarrhs of Lycopodium. Lycopodium may be thought of in catarrh affecting the nasal mucous surface, particularly when the nose is '' stuffed up'' and the child cannot breathe. The child starts up from sleep rubbing its nose. LYCOPODIUM. 415 You may also think of it in bronchial catarrh, whether the larger or smaller tubes are involved, when there is accumulation of mucus, as in- dicated by rales, rattling breathing, cough and dyspnoea. It may also be given in hectic fever with suppuration of the lungs, particularly when the right lung is worse than the left. It is also useful in pneumonia when the hepatization is so extensive that the patient has great difficulty in breathing, and there is alternate contraction and dilatation of the alae nasi. It may also be employed in typhoid pneumonia, the symptoms agreeing, and also for the bad effects of maltreated pneumonia, particularly if suppuration of the lungs impends. In diseases of the kidneys we find Lycopodium indicated for a trouble to which I have already referred, the presence of lithic acid in the urine, and also in renal colic affecting the right side. There is one symptom for Lycopodium that I would yet like to add, a symptom not uncommon in typhoid fever, pneumonia, and scarlatina, and that is coldness of one foot while the other is warm or even hot. This symptom may appear insignificant on paper, but I can assure you that it is of inestimable value in practice. Lycopodium is complementary to Lachesis. LECTURE XLII. THE UMBELLIFERiE, THE BERBERIDACE^ AND SPIGELIA. The Umbellieer^E. The Umbelliferae are an order of plants which have a marked action on the nervous system, developing in some cases symptoms akin to hys- teria. They also affect the glandular system, producing either engorge- ment or atrophy of glands. They all act on the mucous membranes, producing catarrh, and some of them act upon the skin, developing pustular eruptions. The remedies obtained from this order are as fol- lows: Conium maculatum, Cicuta virosa, CEnanthe crocata, Phellandrium aquaticum, Petroselinum, Asafcetida, Ammoniacum gummi. We will now proceed to consider the one first mentioned on this list. Conium maculatum acts as a depressor of the cerebro-spinal system. It develops a paretic state which spreads from below upwards, the lower part of the body giving out before the upper. When the drug is taken in poisonous doses we find at first a difficulty in walking, as though the legs could not be moved. As the action of the poison increases, other and more vital organs are involved. The lungs are attacked; there is dyspnoea; the pulse is irregular, showing the fitful condition of the heart muscle. Up to this time the mind of the patient is perfectly clear. Finally unconsciousness ensues, and the patient dies from pa- ralysis of respiration. We may utilize Conium in those exhausted states of the system re- sulting from old age. It may also be used after severe diseases, as diphtheria and typhoid fever, and for the sequelae of that vice of vices, masturbation. In the paralyses of Conium, sensation is but little CONIUM. 417 involved. Its analogue here is Gelsemium, which produces functional motor paralysis and is a prominent remedy in post-diphtheritic paralysis. In the treatment of the effects of sexual excess, we find Conium of great utility by reason of its mental symptoms. It produces a perfect picture of hypochondriasis. The patient is melancholy, averse to society, yet fears to be alone. Conium may also be given when this mental condition arises from celibacy. Zinc oxide is here very similar to Conium. The latter is a depress- ing remedy, while the former is irritating as well as weakening. You may use Conium in vertigo, when it is the result of cerebral anaemia and when it is characterized by exacerbations on turning over in bed. It is often associated with a numb feeling in the brain, as if that organ was stupefied. Acting as Conium does upon the glandular system, we would ex- pect it to be a scrofulous remedy. It is indicated in scrofulous oph- thalmia; a characteristic symptom calling for it in this trouble, being intense photophobia disproportionately severe to the degree of inflam- mation present. In addition to this there are ciliary neuralgia and prosopalgia, usually on one-side, and worse from cold, under the influ- ence of which the cheek becomes of a dark red color and swells. Conium affects the wax in the ears, increasing it in quantity and making it a dark color, something like chewed-up paper. The proper treatment in these cases is to remove the accumulation of wax by careful syringing, and then give Conium to prevent its for- mation anew7. Conium does not act very prominently on the chest. We find it useful in consumptives when they find it impossible to expectorate the sputum; they must swallow it again. It is especially useful for tor- menting night cough, from tickling as from a dry spot in the larynx. There is scarcely any cough during the day. Conium weakens the heart, causing the pulse to be one moment full and regular and the next soft, weak, and irregular. This symptom is not an uncommon indication for Conium in aged people. The use of Conium in glandular diseases and in malignant forms of tumors comes from its power of producing enlargement of the glands, adenomata. The glands affected are of a stony hardness. These in- durations are quite common in the mammae, in the testicles, and in the uterus. Usually, there is little or no pain; although, sometimes, there may be darting pains. Conium is indicated, perhaps, in the beginning of scirrhus. It is also indicated after contusions or bruises when in- duration is the result. 27 418 A CLINICAL MATERIA MEDICA. There is an inflammation of Conium which closely simulates that of malignant disease. In the mouth it gives us a picture of noma; the tongue and mucous surfaces are swollen, with offensive discharge; the parts have an ashy, grayish hue, and may even be gangrenous. There is great difficulty in swallowing, with spasm of the throat. In cancer of the stomach, there is vomiting of blood, and of a gray- ish-black substance which is made up of decomposed blood and broken- down gangrenous tissue. Conium is complementary to Nux vomica in constipation, especially when there is faint feeling after stool. Ammoniacum gummi is a gum obtained from a very large tree grow- ing in Arabia. It has gained quite a reputation as a cure for diseases of the eye. I have used it successfully in asthenopia, when the eyes smart and burn, especially if used at night by artificial light. The eyes become injected, and often throb, especially in the inner canthus of each eye. It thus stands between Belladonna, which is used for affections of the eyes from overwork when there is great congestion, and Ruta, which is indicated for irritability of every tissue of the eye from overwork or from using the eyes on fine work. Asafcetida is a gum having a decided odor of an alliaceous kind. It is especially useful in two classes of disease: First, in nervous dis- eases developing a perfect type of hysteria; it acts upon the muscular fibres, producing a reverse peristaltic action in the oesophagus and in- testines. Thus, it causes a sensation as though a ball started in the stomach and rose into the throat; this being provoked by over-eating, by motion, or by anything that can excite the nerves. It produces a bursting feeling, upwards, as though everything in the abdomen was coming out at the mouth. This is common in colic from hysteria, after belching of wind of a strong rancid taste, and is associated with an empty gone feeling in the stomach at 11 a. m. The second action of Asafcetida is upon the bones. It produces periosteal inflammations, resulting in ulcers, especially upon the shin bones. A characteristic of these ulcers is an intolerance of all dress- ings. All the parts around it wince under the application of even charpie. We find Asafcetida curing hysteria arising from the sudden suppres- sion of discharges. Asafcetida produces inflammations of the eye. Thus it may be in- dicated in iritis after the abuse of mercury, especially when it is of syphilitic origin, with burning, throbbing pains, and soreness of the THE UMBELLIFER.E. 419 bones around the eyes. The nearest remedy here is Aurum, which has relief by warmth. Asafcetida has relief from pressure on the eye-ball itself, which Aurum has not. Phellandrium aquaticum we find to be indicated in headache which involves the nerves going to the eye. There is a crushing feeling on the top of the head, with burning of the eyes and lachrymation. Phellandrium also causes sharp pains in the course of the lactiferous tubes. Petroselinum comes into use in urethral disease, especially in gonor- rhoea, when the inflammation has travelled back, and the patient com- plains of pain at the root of the penis. There is a sudden irresistible desire to urinate. Conium causes chronic cystitis, with intermittent urination. The urine flows and stops. That symptom of the drug I have utilized in the treatment of enlargement of the prostate in old people. sEthusa cynapium is a frightful poison, having narcotic properties as well as paralyzing effects. The principal use we make of the drug arises from its action on the stomach. It produces a deathly nausea and sickness, with vomiting. In the case of a child the vomit con- sists of curdled milk, which is often green. After vomiting, the child falls back exhausted and goes to sleep. It awakens hungry, it eats and then vomits. The face is pale, and there are dark rings about the eyes. The analogue here is Antimonium crudum, which differs from yEthusa in having a white-coated tongue. Another remedy is Calcarea ostrearum or Calcarea acetica, which has vomiting of curdled milk, and the child is apt to have diarrhoea with sour-smelling stools. Cicuta virosa, another member of the order, when taken in any quan- tity produces congestion at the base of the brain and in the medulla oblongata. At first, the patient is rigid, with fixed staring eyes, bluish face and frothing at the mouth. Next, there passes a shock, or series of shocks, from the head through the body. The patient is often un- conscious, the jaws are locked, the patient bites the tongue. These spasmodic symptoms are followed by profound exhaustion. These symptoms indicate Cicuta in epilepsy, spasms from worms, and also in some forms of puerperal spasms. We notice, too, that Cicuta, in addition to these symptoms, de- velops phenomena which resemble the remote effects of concussion of the brain. The pupils are dilated; there are also vertigo and head- ache. Cicuta also attacks the skin, producing a pustular eruption, with 420 A CLINICAL MATERIA MEDICA. yellowish honey-colored scabs, particularly about the mouth, and matting the whiskers. It has even cured two cases of epithelioma when the cancerous growth was covered by these honey-colored scabs. Next, we will study the BERBERIDACE^E. Of this order we have time to study but two drugs, namely Berberis vulgaris and Podophyllum peltatum. Berberis Vulgaris. Berberis vulgaris belongs to the order Berberidacece, along with Caulophyllum and Podophyllum. It contains an alkaloid called Ber- berina, which, by the way, is also found in Hydrastis Canadensis. Some chemists have even asserted that what is sold as Muriate of Hydrastine is not Hydrastine ax. all, but Muriate of Berberine. This Berberine, when given in large doses to animals, produces restlessness, convulsive trembling, thirst, diarrhoea and, finally, paralysis of the posterior extremities. Man is far less readily poisoned by it than are the lower animals. Berberis vulgaris acts more on the kidneys and bladder than on any other parts of the body ; next to these the liver, and, lastly, on the mucous membranes. It also affects the vital powers and damages nu- trition, as shown by the sunken face and excessive prostration. First of all we will consider the kidney symptoms as the most im- portant. Just as I would say that I would recommend Digitalis for several diseases when the heart symptoms decide for it, so would I recommend Berberis in certain affections, peritonitis, metritis, etc., when the Berberis kidney symptoms predominated. We find in the renal regions sticking, digging, tearing pains, worse from deep pressure, for they are evidently in the kidneys themselves. These tearing pains extend down the back and into the pelvis along the course of the ureters. There is a sort of tensive, pressive pain across the small of the back; the back feels stiff and numb; pains of a sticking or tearing character radiate from the kidneys down into the small of the back. Another symptom which seems to be peculiar to Berberis is a bubbling feeling as if water were coming up through the skin. It is a peculiar symptom, and one that may point very strongly to Berberis as the remedy. Coming next to the bladder, we find very marked here cutting in the BERBERIS. 421 bladder, extending down the urethra, burning pain even after urinat- ing. The urine itself presents marked characteristics. We find it yellow, turbid and flocculent. Sometimes the sediment is whitish, later becoming red and mealy. With these urinary symptoms are the tearing pains just mentioned. Now, whenever you have these renal and vesical symptoms, you must think of Berberis, whether the trouble be inflammation of the uterus, of the bowels, of the peritoneum, or of any other part of the body. The face is usually expressive of deep- seated disease, being sunken and worn looking. General prostration is great. Sometimes the same condition obtains in liver affections. You find very characteristically sticking pain under the border of the false ribs on the right side. These pains seem to shoot from the hepatic region down through the abdomen. These symptoms may be indicative of the presence of gall stones. The stools of Berberis are accompanied by violent burning in the anus, as if the surrounding parts were sore; frequent or constant desire for stool. These symptoms have suggested the use of Berberis in fistula of the anus. You may also use Berberis in complaints of females, when the leu- corrhcea or menstrual difficulty is associated with the peculiar urinary symptoms of the drug. Berberis is to be studied alongside of Pareira brava. The difference between the two drugs is this: In the latter drug the pains go tearing down the thighs, while in the former they seldom go further than the hips. When a fistula in ano has been operated on and other affections follow, Calcarea phos. is the remedy. We may also use Berberis in diseases of the joints, when there are these tearing and burning pains and this bubbling sensation. It is also a very useful drug in rheumatism or gout, when characteristic urinary symptoms are present. This places it by the side of Lithium carb., Benzoic acid, Calcarea ostrearum and Lycopodium. Benzoic acid is useful in gout and in rheumatism with urinary symptoms, when the urine smells very strong, the odor of the urine being compared with that of the horse. Calcarea ostrearum has very offensive urine, with a white instead of a turbid deposit. Lycopodium is useful in rheumatism or gout when the urine contains a lithic acid deposit. 422 A CLINICAL MATERIA MEDICA. Podophyllum Peltatum. Podophyllum peltatum is the mandrake or May-apple; it also is a member of the order Berberidacece. It is a plant that grows to the height of some two or three feet, with leaves spread out like an open hand. It is found mostly on the borders of woods. The parts used in medicine are the roots and fruit of the plant. When applied externally, Podophyllum produces a rawness of the skin, resembling intertrigo. If the powdered plant gets into the eyes it produces an inflammation of the eyes, and even a perforating ulcer of the cornea. The central point of attack of the drug, however, is in the abdomen. Shortly after it is taken there follow diarrhoea, colicky pains, the well- known morning stool pouring out like water from a hydrant, preceded by retching and vomiting, spasmodic contraction of the stomach making the child scream out; diarrhoea which makes us think of Sulphur, Dioscorea, Bryonia, Natrum sulph., and a few other remedies. In addition to its intestinal action we find it acting on the liver, and here is the main use that is made of the remedy. In the torpid or chronically congested liver, it is indicated. The liver is swollen and sensitive, and friction over the right hypochondrium relieves this sensa- tion. The face and sclerotica become tinged yellow. There is bad taste in the mouth, evidently arising from the degeneration of food in the intestinal tract. The tongue is coated yellow or white, and takes the imprint of the teeth. The bile may become inspissated in the gall bladder, forming gall-stones; thus we find Podophyllum indicated in that tormenting disease, bilious colic. The stools are as already men- tioned; or they are constipated and clay-colored, showing the absence of bile. These symptoms of Podophyllum much resemble those of Mer- curius. They have won for the drug the name of vegetable mercury. It is much less injurious, however, than is Mercury. Of the remedies producing the symptom, the tongue takes the im- print of the teeth, Mercurius stands at the head of the list. Next to that we have Podophyllum, and then Yucca filamentosa, and, finally, Rhus, Stramonium and Arsenicum metallicum. Podophyllum also produces prolapsus recti with the diarrhoea. The rectum protrudes before stool {Nux vom. after), especially in the morn- ing. Podophyllum also seems to have the power of producing and curing prolapsus of the uterus with the attendant symptoms of bearing down with neuralgia in the right ovary, extending down the thigh, backache, and often coexisting with these, prolapsus recti. SPIGELIA. 423 As concordant remedies to Podophyllum in this prolapsus we have Nux vomica and Sepia. Podophyllum is a valuable remedy during dentition. It does not seem to act on the brain, yet it causes reflex cerebral irritation, whether this be from the abdominal symptoms alone or from the teeth. The symptoms which indicate it in addition to the gastric symptoms, are moaning and whining during sleep (not crying out with a sharp, sudden noise, as under Belladonna, but a sick cry); the child grates its teeth; the head is thrown back and rolled from side to side. Next we find Podophyllum indicated in fevers, usually of a remittent type, particularly in bilious remittent fever. During the chill the drug does not produce many characteristic symptoms; but during the fever the patient is sleepy and sometimes delirious. For the remainder of the hour I will speak of a drug which is not botanically related to either of the drugs I have been speaking of, and that is Spigelia. Spigelia Anthelmintica. Spigelia is a member of the order Loganiacece. To understand it as a remedy is not a difficult thing to do, if we start with the idea that it acts on the nerves as a neuralgic remedy, having as a grand char- acteristic, neuralgia. Associated with these neuralgic symptoms we almost always find symptoms sympathetic from the head, whether these be neuralgic or not. Mentally, we find the patient exhibiting fear, anxiety, forebodings, as though something was about to happen. This is a very common symptom with nervous neuralgic men and women, especially those whose nerves are very much weakened. Another symptom which sometimes appears is tearfulness of pointed things; for instance, the patient is afraid of pins. There is often, also, praecordial anguish. The neuralgia itself, if it involve the head, begins in the occiput and comes forward and settles over the left eye. It may also involve the cheeks, especially the left. It also has burning, jerking, tearing pains, worse from any noise or from any jarring of the body. They are usually worse, too, in change of weather, especially in stormy weather. At the acme of the pain there is usually bilious vomiting. The period of exacerbation is quite marked. The pain begins in the morning with the sun, increases during the day, and diminishes toward evening. 424 A CLINICAL MATERIA MEDICA. We often find Spigelia indicated in sick-headache when the patient can bear neither noise nor jarring of the body. Spigelia is our mainstay in ciliary neuralgia. This may be in either eye, more frequently, however, in the left. The eye symptoms are the following: There may be photophobia from slight retinitis; sharp stabbing pains in the eye, or radiating from the eye. The supra- orbital region is tender to touch. The eye-ball feels swollen as if too large for the orbit. Associated with these symptoms are lachrymation and coryza. Three remedies are here to be compared with Spigelia. The first of them is Mezereurn. This is useful in ciliary neuralgia. The pains radiate and shoot downward. There is a cold feeling in the eye as though a stream of cold air was blowing on the eye. It is especially indicated when the bones are involved, especially after the abuse of Mercury. Another remedy is Thuja. This is useful in ciliary neuralgia. Like Mezereurn, it has cold feeling in the eye, but the pains take the opposite direction, they go upward and backward. Still another remedy to be thought of is Cedron. Spigelia is a valuable heart remedy. It is to be thought of when there are sharp stitching pains referred to the left chest, and shooting into the arm and neck; when, on placing the hand over the heart, there is a peculiar purring feeling. The patient is worse from the slightest motion of hands or arms. He cannot lie down. The pulse is not synchronous with the heart. Spigelia may be used in worms. It causes the following symptoms: Strabismus from abdominal irritation, jerking over the eyes, paleness of the face, with blue rings around the eyes. The patient feels faint and nauseated on awaking in the morning when there is hunger, which is relieved by breakfast; colic worse about the navel; stool consisting of mucus, faeces and worms. LECTURE XLIII. MINERAL KINGDOM. I propose now to begin the study of the drugs obtained from the mineral kingdom. I have placed on the board {see next page) for your study the elements, with some of their relations, just as we find them in chemistry. They have not been arranged thus to suit the materia medica. This is not an absolute arrangement which cannot be altered without destroying its correctness. I wish to explain here the general idea of the relation of drugs, and especially of those belonging to the mineral kingdom. If you consult chemistry you will find that the elements hold to each other an electrical relation. They hold to each other a relation of polarity as positive electric and negative electric. Certain of these elements are emphatically negative, and others are just as positively positive. Some of the elements, as gold, silver, etc., hold a middle relation, being rather neutral. These I have placed at the neutral point of the magnet. The advantage of this method of study will be seen as we proceed. The negative electrics are known to be conductors of light, the positive conductors of heat. The ex- treme effects in this respect are noticed at either pole, diminishing as we approach the curve of the magnet. Another fact which is well worth knowing, is this general statement: The electro-negatives act on the bowels in the morning, and the chest in the afternoon; that is, they act upward on the body during the day. Exactly the opposite holds true with the electro-positive. These act on the chest in the morning, and on the bowels in the latter part of the day. Most of you are acquainted with the morning diarrhoea of Sulphur, which hurries the patient out of bed. You know how the asthma of that remedy increases in the afternoon. Taking the remedies at the other extreme, we have the Kali salts as examples; you know that they have aggra- vation of their chest symptoms in the forenoon, and of their bowel symptoms in the afternoon. This is, of course, a very general state- ment, but it may be of great use to you in enabling you to differentiate between drugs. Let me illustrate. You have a case of scrofula and you are obliged to decide between Sulphur and some salt of lime. You will be astonished to see how similar are many of the symptoms of these two drugs. The very fact of the diarrhoea coming in the morn- 426 A CLINICAL MATERIA MEDICA. Electro- Electro +. Oxygen. Ozone. Nitric ac. Amyl nitr. Ant ozone. Sulphur. Selenium. Sulph. ac. Carboneum sulph. Fluoric ac. Iodine. Spongia. Bromine. Chlorine. Muriatic ac. Cyanogen. Hydrogen. Ammonium. Kalium. Natrum. Lithium. Carbo veg. Carbo an. Graphites. Petroleum. Cosmoline. Silicea. Phosphorus. Phosphoric ac. Arsenicum alb. Arsenicum iod. Tellurium. Antimon. crud. Antimon. tart. Calcarea. Baryta carb. Strontia carb. Zincum. Magnesium. Cadmium. Alumina. Plumbum. Stannum. Aurum. Argentum. Mercury. Thallium. Cuprum. Platina. Palladium. Ferrum. Manganum. Niccolum. Kobaltum. Iridium. Indium. Rhodium. y" Osmium. MINERAL KINGDOM. 427 ing or afternoon, insignificant as it may appear under other circum- stances, acts as a symptom of differentiation between these two drugs. Now in making this statement I do not mean that because Sulphur produces a morning diarrhoea, that it must always be the remedy when that symptom is presented ; but I do mean that when you are com- pelled to decide between two remedies having opposite directions in action, this relation becomes of great importance. As you approach these remedies or chemicals at the neutral point of the magnet, you find these effects less and less marked, until, finally, they are unnotice- able. There is another fact which we may learn from this arrangement of drugs. You notice that here wre have oxygen and sulphur. They are chemical elements, which are placed near together in chemistry, and are similar not only as chemicals but also as medicines. Next on the list we have nitrogen, which is used in medicine in the form of Nitric acid. Below this we have a list of remedies which constitute a group in chemistry known as the halogens ; they consist of Fluorine, Fluoric acid, Iodine, Bromine, and Spongia. The latter drug is placed here not as a chemical substance, but as a drug which owes its medi- cinal properties to the iodine and bromine which it contains. It is of practical value to remember these drugs in this connection, because they are not only chemically similar, but they are also similar as medicines. Moreover, this grouping of remedies enables you to keep in mind a group of remedies from which you may choose one to suit your case. I have introduced cyanogen here because it holds important chemical and medicinal relations to the halogens. Below we have the carbon group, Carbo veg., Carbo animalis, Anthrakokali, the diamond, and Graphites. I have also placed in this group Petroleum and Cosmo- line, two oily substances, rich in carbon, and having many resemblances to the pure carbons. You will find in a future lecture, that I can show you characteristics which belong to all the carbons. You will say that here is a patient who needs some preparation of carbon, which shall it be ? This you determine in the same way as you selected one of the halogens. Next we have a group composed of Phosphorus and its acid and Arsenicum. Below, we have Tellurium, Antimonium crudum and Antimonium tartaricum, which is similar enough to the sulphide to be placed along side of it. This group of drugs possesses many similarities. Phos- phorus and Arsenic are continually in the physician's mind placed in contrast, and it is often difficult for him to decide which he shall *give. 428 A CLINICAL MATERIA MEDICA. The Antimony preparations are similar in form and isomorphous with Sulphur and Selenium. There is another fact which we may borrow from chemistry, and that is that substances of similar crystalline struct- ure have similar medicinal effects. These substances often replace each other in chemistry. I give you these facts so that you may have a rational conception of drugs, not as mere individuals, but as consis- tent with nature and with themselves. Here below we have the noble metals, gold and silver. Then we may go up on this side tracing the drugs through the same relation wTe did on the other. Every one knows how closely related, chemically and medicinally, are Barium and Strontium. This relation is very much like that of similarity in origin. They are not apt to follow one another well. Here are Sul- phur and Sulphuric acid; suppose you are going to decide between them and suppose it to be a perplexing case. You say "I will give Sulphur, and if he is not better to-morrow I will give Sulphuric acid." That is bad practice. It would be much better to say that I will give Sulphur to-day and Calcarea to-morrow. Why ? They are similar drugs but entirely foreign in their family relations. Why do I dwell on these two relations ? Because I want you to distinguish between that which is the same and that which is similar. Ignatia and Nux vomica are too much as though they were the same thing. Ignatia and Zinc are concordant remedies which are similar but which are not identical. You note that I have placed hydrogen above all the potash salts. You notice that here is placed antozone. Ozone is negative oxygen, and antozone is positive oxygen. Ozone exists in the sea-air and how many times do you send your patients to the sea-shore for relief. We may derive a hygienic fact from this statement; if I have a patient who is something of a Sulphur patient, I would think that sea-air would do him good because sea-air is rich in ozone, and ozone in a general way suits his condition. On the other hand, if he belongs more to the " salt" class of drugs I would not send him to the sea- shore. I would send him where antozone exists, as in fogs. We will now proceed to study the drugs derived from the mineral kingdom. The remainder of the hour I will devote to the consideration of Sele- nium. To-morrow we will study that king of remedies, Sulphur. Selenium. fArumtri. < Cinch. Selenium J Caust., Carbo v., Phos., Spong. 5^me' ♦ [Sulphur. Nux, Puis., Merc. Sulphur is an element with which you are all familiar. You must be careful, if you prepare the medicine yourself, that you obtain it perfectly pure. The sublimed Sulphur that you buy in the shops is very impure. It contains some of the oxygen acids of Sulphur, some Selenium, and often, too, Arsenic. When chemical substances are associated in this way in nature, it is a fact that they must be re- lated medicinally. There is also a relation between the plant and the soil in which it grows. Thus, Belladonna, which grows in lime earths, is related medicinally to Calcarea. The Agaricus will never grow where there is coal. You will find no relation between Agar- icus and the carbons. Cistus Canadensis grows where there is mica, consequently you may expect some relation between that drug and Magnesium. Sulphur may be said to be the central remedy of our materia medica. It has well-defined relations with nearly every drug we use. The great utility of Sulphur arises from this peculiarity, it is our mainstay in defective reaction. When the system refuses to respond to the well- selected remedy, it matters not what the disease may be, whether it is a disease which corresponds characteristically with the symptomatology of Sulphur or not, it will often be the remedy to clear up the case and bring about reaction, and either itself cure the case or pave the way for another drug which will cure. This quality of Sulphur arises from its relation to what Hahnemann called psora. Hahnemann taught what is practically true, that when a disease is suppressed (and a dis- 28 Sulphur. V V V Calc ostr., Aeon., Aloes. 434 A CLINICAL MATERIA MEDICA. ease is suppressed when it is driven from the surface to the interior of the body), there is formed a constitution or dyscrasia which will after- wards modify every abnormality from which the patient may suffer. For instance, an eruption on the skin is dried up or is driven in by some external application. Afterwards (it may be some time), another disease may appear. Now, this does not come necessarily as a skin affection. Pathologically, it may be entirely different from it. For instance, as the result of exposure to cold, the patient contracts pneu- monia. This suppressed eruption so modifies the disease that it is not curable until that same eruption is reestablished on the skin. Then you will be amazed to see how promptly the remedy that before refused to act now cures the case. Many times has Sulphur restored such sup- pressed diseases, and in this fact lies its wide application in practice. Particularly is it applicable after the suppression of itch. Sulphur is especially adapted to persons of rather light complexion (although dark-complexioned persons may also yield to its influence) who are easily angered. It is one of our mainstays in the treatment of the negro. Whether this is owing to the rapid growth of scrofula in that race or not, I cannot say. It is also suited to persons who are subject to skin affections, particularly to those who have harsh, rough skin, which very readily breaks out with eruptions of various descrip- tions, varying from a simple erythema to a positive eczema. There is apt to be also an offensive odor from the body. This odor may arise partly from uncleanliness, for the typical Sulphur patient is not very fond of water. Bathing aggravates his complaints. There is, more- over, a positive distaste or dislike for water. This peculiar disa- greeable odor or exhalation from the skin is not removed by wash- ing; hence, you must consider it to be an abnormality arising from impure excretions from the skin. The patient is rather of coarse^ fibre. His hair is harsh and coarse. There is craving for alcoholic drinks, especially those of the coarser type, as beer, ale, whiskey, etc .' The patient walks rather stooped from weakness of the spine. Thenf too, as I have already said, he fails to react to the apparently indicated remedy. In defective reaction, Sulphur does not stand alone. I have already spoken of the value of Psorinum in this connection. Cuprum should also be thought of. We also have Laurocerasus in chest affections, particularly in diseases of the lungs which do not respond to treat- ment; Valerian and Ambra grisea in nervous diseases; and Carbo sulphur. 435 veg., particularly in abdominal affections and in the collapse which is marked by cold breath, cold knees, etc. Now, let me speak of the action of Sulphur on the circulation. In almost every instance in which it is the remedy you will find deranged circulation. It seems to act prominently on the venous circulation, producing a sort of plethora. But this is not a true plethora. It is the result of irregularities in the distribution of the blood, by which certain parts of the body become congested. These congestions, gen- erally speaking, are such as occur particularly from abdominal troubles, especially fulness of the portal system, a very common trouble nowa- days. Especially is Sulphur indicated in plethora that has arisen from sudden cessation of an accustomed discharge, particularly a haemor- rhoidal flow. For example, piles have suddenly stopped bleeding, and fulness of the head, with distended blood vessels, fulness of the liver, etc., show that congestion of these parts has resulted. Sulphur will, in these instances, ease the congestion and restore the accustomed discharge. Then you may proceed with Sulphur or with some other remedy, according to the indications of the case, to cure this abnormal discharge in the proper way. The congestion of the head, for which Sulphur is indicated, is ac- companied by roaring in the ears (hence there is congestion about the auditory nerves), redness of the face, this symptom being worse in the open air and better in the warm room. The head feels heavy and full almost to bursting. The patient feels worse when he stoops. Sulphur is frequently indicated in congestion of the chest with or without haemoptysis. There is great difficulty in breathing. The pa- tient feels oppressed and wants all the doors and windows opened. These symptoms are accompanied with violent palpitation of the heart, that organ trying to compensate for the increased supply of blood to the thoracic cavity. If I may be allowed to use the expression, there is too much blood in the heart. The blood rushes into that organ and is not removed by its contraction rapidly enough. This is a very common symptom indicating Sulphur, and especially calls for it when the patient is dis- turbed at night with sudden rush of blood to the heart, with violent palpitation, gasping for breath, feeling as if the patient would suffocate if fresh air is not obtained. These symptoms may also be experienced during the day from ascending a height or from execise where the heart is called upon to do extra work. Often the patient feels as if the heart was too large for the thoracic cavity. 436 A CLINICAL MATERIA MEDICA. As further evidence of the irregular distribution of the blood in Sul- phur, we have redness of the various orifices of the body. This symp- tom is very characteristic of the remedy. The lips are of a rich red color. This symptom often indicates Sulphur in pneumonia, scarla- tina, dysentery and anaemia. Redness of the ears may be noticed even when the rest of the body is not abnormal in color. With this last indication, Sulphur has often prevented earache in children. With this indication it has often prevented erysipelas. We also find this redness along the borders of the eyelids, giving them an appearance as if they had been painted. We find redness at the anus, with soreness of the part. That symptom is particularly useful in the diarrhoea of children. The child screams with pain when the bowels are moved. That symptom alone may frequently lead you to decide that Sulphur is the remedy. The same symptom is also true of the vulva, which is found to be red. Another and very common expression of the irregularity in the cir- culation is flushes of heat. It is not particularly the flushes of heat that occur at the climacteric for which Sulphur is indicated, but it is the flushes of heat which may occur in any disease and do occur during convalescence. The "flush" is followed by more or less moisture, which gives relief. To be purely characteristic of Sulphur, this is often associated with other symptoms, such, for instance, as sensation of heat on the top of the head. The feet, in such cases, are apt to be cold and the patient complains of weak feeling in the epigastrium, this being especially worse in the forenoon from ten to twelve. While you often cure flushes of heat with Sulphur when this symptom is absent, you never fail if you have this heat on the top of the head, cold feet and sinking feeling in the epigastrium. In the flushes of heat at climaxis you may also think of Lachesis, Sulphuric acid, Nitrite of Amy I and Kali bichromicum. Another illustration of the action of Sulphur on the circulation is shown in the fever of the remedy. Sulphur is not particularly indi- cated in typhoid or septic conditions. There is no indication that Sul- phur makes changes in the structure of the blood such as belong to scarlatina, typhoid fevers and to septic conditions generally, so that from this fact we could not give Sulphur. There are other reasons than the septic changes that enable us to give Sulphur. It is indicated when the fever is of a remittent or continued type. It may be used after Aconite for the pure synochal fever when, despite the use of that remedy, the dry, hot skin remains and there is no reaction or no critical SULPHUR. 437 sweat, which will give the necessary relief. Hour after hour, day after day, this fever continues; hence its name, continuous. Or it may be what has been termed a "continuous remittent;" that is, there is an exacerbation each evening and a slight fall towards morning, the fever never going away entirely. You may give Sulphur when this fever approaches the typhoid condition, led by these indications: The patient begins to be drowsy with his fever. His tongue is dry and red at the edges and tip, and he responds to your questions very sluggishly and slowly. The patient is literally burning up with the fever. The con- sumption of oxygen of the system is producing these symptoms. Sul- phur acts marvellously in these cases. Sulphur may also be indicated in intermittent types of fever. It is not a specific for intermittent or malarial fever, and yet it has periodi- city in its symptoms. Here you must select it from the well-known symptoms, torpor with slowness in answering questions,, chills will not stop despite your well-selected remedy, particularly if the intermittent assumes the remittent type, or, more frequently, if the remittent type commences and runs into the intermittent. It may also be called for in malarial neuralgia occurring mostly in the face and recurring quite periodically and resisting other remedies. Here, too, you must remem- ber Cinchona and Arsenicum. In these fevers I would have you place Sulphur alongside of two other remedies. These usually follow Sulphur. In their symptom- atology they suit a more advanced case than does Sulphur. These two remedies are Baptisia and Arsenicum. Baptisia typifies a fever which is decidedly typhoid in its tendency. The case is a decidedly worse one than that calling for Sulphur. The torpor does not stop with this sluggishness in responding to questions, but it goes on to stupor, so that the patient even falls asleep while answering you. The tongue becomes of a brown or blackish hue down its centre and sordes form on the teeth. The discharges from the mouth and from the bowels have an offensive odor; the face has a besotted look; the blood is actually decomposed from septic poisoning or from the prolonged high temperature. Arsenicum suits inflammatory fever further advanced than that calling for either Sulphur or Aconite. It has some symptoms which remind you of the latter remedy, notably restlessness ; full, bounding pulse; hot, dry skin; anxiety and fear of death; yet beneath all these symptoms, there is evidence of profound tissue-changes. The inflam- mation is going on to destruction of the parts involved, w7hether the 438 A CLINICAL MATERIA MEDICA. disease be typhoid fever or a simple inflammatory affection from cold, as in gastric catarrh. The symptoms are aggravated after midnight; there is burning thirst with tendency to drink little and often, or burn- ing thirst with refusal to drink water because it aggravates these symptoms, especially the burning like coals of fire in the part affected. With all these symptoms the brain may remain perfectly clear. Next, we come to the consideration of the action of Sulphur on the lymphatic system, including under this head the glands and the ves- sels themselves. Sulphur is our mainstay in scrofula, which is, as you know, an affection involving this lymphatic system. It is the prince of remedies here. It is especially useful in the very commencement of the dissase, when its first evidences are presented, particularly in patients having the temperament which I have already described to you as characteristic of the Sulphur patient. The patient sweats about the head, particularly during sleep. There is a marked tendency to eruptions such as crusta-lactea, boils, and, in older children, acne. In the case of children, the head is large in comparison with the rest of the body. The fontanelles, particularly the anterior, remain open too long from defective osseous growth. There is tendency to bone affec- tions, to caries, and particularly, in early childhood, to rickets and to curvatures of the spine. The child has a voracious appetite. This it expresses by greedily clutching at all that is offered it, whether edible or not, as if it were starved to death. There is defective assimilation. Glands are so diseased that, while sufficient food is taken into the sys- tem, it is not appropriated to the nourishment of the body, so that the child is always hungry and yet emaciated. The child looks shrivelled and dried up, like a little old man; the skin hangs in folds and is rather yellowish, wrinkled and flabby. All these are precious symp- toms for the exhibition of Sulphur. You may occasionally have to use Sulphur in the beginning in a sort of negative condition. You are certain from a majority of symptoms that you have a case of scrofula, and yet no particular remedy appears to be indicated. Then you should give Sulphur, which develops the symptoms and shows you what you have to contend with. In marasmus of children you may give Sulphur when many of the symptoms already mentioned are present. The child is ravenously hungry, especially at n a. m. Now, in regard to this eleven-o'clock hunger, I would say that if you want to use Sulphur successfully in these cases, you must also have these symptoms present: Hunger at u a. m., heat on top of the head and cold feet. If you have these three SULPHUR. 439 symptoms present, Sulphur never fails you. If there is heat on the top of the head alone, you must think of Calcarea or Phosphorus. Another affection of which I wish to speak under the head of the lymphatic system is tuberculosis, not that I wish to say that scrofula and tuberculosis are identical, but that the lymphatic vessels have con- siderable to do with the spread of tubercle. Sulphur is a valuable drug in tuberculosis, no matter what part of the body it may invade. It is especially useful in tubercular hydrocephalus. Here it has done good work, not in the third stage, when the case is nearly hopeless, but in the commencement of the pathological process, when there are violent convulsions, sudden flushing of the face; the child cannot hold its head up from weakness of the cervical muscles. The child wants to lie with its head low. That symptom expresses a great deal, because, when the head is low, there is less effort of the neck required to hold the head up. The child cries out in its sleep. Often, on falling off to sleep, there is sudden jerking of one or both legs. It cries out in sleep as if frightened. The face is red and the pupils are dilated. This is not a case for Belladonna. Belladonna cannot, never did, and never will cure tubercular meningitis. The symptoms tend to appear more or less periodically. Associated with these few cerebral symptoms you will have very many general symptoms, some of which I have already men- tioned, and some of which will be spoken of before the end of the lec- ture. When I give you these symptoms in different groups, I do not wish to convey the idea that these symptoms indicate the drug only when they occur in their respective groups. In tuberculosis affecting the lungs, Sulphur is indicated only in the beginning. I would here caution you as to how you use the drug. If carelessly or wrongly given, it may precipitate the disease which it was your desire to cure. You must not repeat your doses too frequently, and you must never give it unless you are certain that it is the remedy, for the tendency of Sulphur is to arouse whatever lies dormant in the system. The particular indications for Sulphur are these: The body feels too hot. The patient wants the windows open, no matter how cold the weather may be. There are frequent flushes of heat, empty feeling in the stomach, heat on top of head, cold feet, etc., palpita- tion of the heart on ascending, pain through the left chest from the nipple to the back. Now you may, in this condition, give Sulphur as high as you choose, one, two, or three doses and await results. Watch your patient carefully, and in many instances a cure will result, but not in all. 440 A CLINICAL MATERIA MEDICA. In tuberculosis affecting the mesenteric glands Sulphur is indicated by the symptoms that I have already mentioned under emaciation and scrofula. You may also find Sulphur indicated in hip-joint disease, and in white swelling, both of which are probably of tubercular origin. You will be aided in your selection of the drug by the general symp- toms. In these tubercular troubles you may compare with Sulphur Calcarea ostrearum and Phosphorus. Both of these remedies are suited to scrofu- lous children, generally after Sulphur. They are indicated more by the general character of the patient than by the brain symptoms alone. All three remedies, as you know, have the same imperfect growth of tissue. The Sulphur patient is apt to be thinner than the one of Calcarea ostrearum, but Calcarea especially suits a fat, flabby, apparently well- nourished child; the paleness and the softness of flesh show you that the growth of fat has been obtained at the expense of other tissues. The sweat of the Sulphur patient has an offensive odor; with Calcarea the sweat is on the scalp, and is cool. Calcarea phosphorica gives you these symptoms: There is tendency to emaciation rather than obesity; the abdomen may be large, but is more apt to be flabby; the fontanelles, especially the posterior, remain open too long. Still another remedy is Apis. You know that Apis is one of the best remedies in tubercular meningitis. It is very similar to Sulphur. Both remedies are indicated in cerebral symptoms arising from the repercussion of some eruption—Sulphur, if it is a chronic eruption, and Apis, if it is an acute one. Even here they collide. The best distinction to make is this: Apis is indicated when there is well-marked effusion on the brain; the patient cries with a piercing shriek. Then, again, the restlessness of the two remedies ought to be compared. With Sulphur, the patient does not sleep at all, or it starts up from sleep suddenly, or sleeps in cat-naps. In Apis, we have this picture: The child is sleepy; it suddenly awakes from sleep with a shrill cry; it may be wholly or partly conscious; it is sleepy, but cannot sleep. Sulphur acts as powerfully on the nervous system as it does on the circulation. It affects the brain, producing first some alterations in the functions of that organ. For instance, it may be useful in hysterical states, when the general symptoms of Sulphur are present; when the patient has the insane idea that she is very wealthy; she tears up her SULPHUR. 441 clothes regardless of the consequences; she plays with and examines old soiled rags with pleasure, evidently regarding them as objects of beauty. At other times there is profound melancholy, with disposition to do nothing at all; she is perfectly listless. This is not the indiffer- ence of Phosphoric acid, but listlessness or torpidity that is very com- mon in hypochondriasis. At other times the patient is affected with a religious mania; even this mania is remarkably egotistic; the patient fears that she will not be saved; there is anxiety about one's own soul, with perfect indifference concerning the salvation of others. At other times the patient is intolerably irritable and peevish; this is particularly true with children. Again, Sulphur may be indicated in hydrocephaloid. I have tested it fully in this condition, and know it to be invaluable. The hydro- cephaloid comes in during the course of cholera infantum. The little patient lies almost in a stupor. The face is pale, and bathed in a cold sweat, particularly the forehead. Do not mix the case up with Vera- trum. The eyes are half-open,'and you find the pupil reacting very sluggishly to light, the urine is suppressed (a very alarming symp- tom); the child occasionally twitches or jerks one or the other limb, and may now and then start up from sleep with a cry. That is a con- dition in which you will find Sulphur to act like a charm, and that, whether the diarrhoea continues or not. There is no remedy which can take its place. There is not in the case the violent rolling of the head, the suffused face, or the crying out of Belladonna, nor is there the cri en- cephalique belonging to Apis, but there is a group of symptoms peculiar to Sulphur. Sulphur acts on the spine, producing several conditions there; first of all, it is useful in spinal irritation. On presssing between the ver- tebra, you notice how the patient winces. Sulphur may also be used in spinal congestion, when the trouble results from suppression of the menses, or, still more particularly, from the suppression of a haemor- rhoidal flow. The back is so sensitive that any sudden jarring of the body causes sharp pains along the spine; there is dry heat, particu- larly in the small of the back, and this is often associated with cold feet. We also find it indicated in paraplegia, or paralysis of both legs. Sulphur has produced this, and it can cure it. I do not think that Sulphur is well indicated in far-advanced cases resulting from either sclerosis or softening of the cord, or from chronic inflammation of its meninges; but it has done good work in paralysis of both legs, with 442 A CLINICAL MATERIA MEDICA. total retention of urine, and numbness extending up to the umbilicus. When the urine is drawn by the catheter it is found to be turbid and highly offensive. Now Sulphur must be given persistently in these cases. I must say that it will not always cure, for many cases are in- curable, but it will cure some cases in which the central cause of the trouble is not so chronic, and in which the alterations in the structure of the cord are not so profound but that they can be removed. General weakness of the spine, not classed under any particular name, has been sometimes cured by Sulphur. The patient has the characteristic stooped appearance of Sulphur. The chest feels empty and weak; it tires him to talk; there is weakness in the epigastrium during the forenoon. We may also use Sulphur w7hen these symptoms occur during convalescence from various acute diseases. We next have to speak of the action of Sulphur on the muscles. ligaments, tendons and joints. Sulphur is indicated in acute and chronic rheumatism, particularly the latter, when the inflammatory swellings seem to ascend; that is, they" begin in the feet and extend up the body. The pains are worse in bed, and at night. The patient uncovers on account of burning heat of the feet. Especially do we find Sulphur useful during the course of acute inflammatory rheuma- tism for that annoying symptom, jerking of the limbs on falling off to sleep. We may also use it in synovitis, particularly after exudation has taken place. Sulphur here produces absorption, and very rapidly, too, particularly in the knee. We come next to study the action of Sulphur on the serous mem- branes. I have already spoken of its use in tubercular meningitis, so I now speak of its action on the pleura. We find Sulphur indicated in pleurisy, particularly when you have that sharp stitching pain through the left lung to the back, worse lying on the back, and worse from the least motion. It is also useful in cases that refuse to respond to the well-chosen remedy, particularly when there is well-marked pleuritic effusion. Apis is also to be thought of in this condition. In peritonitis Sulphur is indicated more by the general symptoms than by those directly referable to the affected part itself. We next come to the action of Sulphur on the mucous membranes. Here we will consider its use in catarrhs and pneumonia. We find Sulphur indicated first of all in conjunctivitis. It is especially useful when the trouble has resulted from a foreign body in the eye, particu- larly after Aconite fails. It is also useful in scrofulous inflammations SULPHUR. 443 of the eye, especially with the characteristic tendency of this remedy to congestion. The eyes are red and injected, and there is a feeling as of a splinter of glass in the eye. The inflammation is worse in hot weather. During the winter the child is comparatively free from trouble. This symptom then is due to the relaxing influence of heat. The child is worse when near a hot stove. With the above symptoms to guide us, we may also use Sulphur in keratitis. In nasal catarrh or coryza we find Sulphur indicated in those who are subject to catarrhs, especially chronic catarrh, when scabs form in the nasal cavity, the nose bleeds readily, and is swollen, the alas especially are red and scabby, this redness at the outlet of the nose being quite consistent with the Sulphur condition. The nose is " stuffed up" while in doors, but when the patient is out in the open air, breathing is un- obstructed. Coming next to the throat and lungs, we find Sulphur indicated in laryngitis and also in bronchial catarrh. Hoarseness is present, and this makes the voice very deep, a sort of basso profundo. In other cases there is aphonia, which is worse in the morning. The more chronic the case the more is Sulphur indicated. In bronchitis, especially chronic bronchitis, Sulphur is indicated when there seems to be an enormous and persistent accumulation of thick muco-pus. The patient suffers from spells of suffocation, with palpitation of the heart. He must have the windows open. The cough is worse when he is lying in a horizontal position, and may then be so violent as to cause nausea and vomiting. Sulphur may sometimes prevent pneumonia by relieving the lungs of that hyperaemia which necessarily precedes the deposit of plastic matter. If in the very begin- ning you give Sulphur you will prevent the disease, providing, of course, that remedy is indicated. If you are too late to prevent it you may still use Sulphur when exudation has commenced—that is, in the beginning of the stage of solidification. Even then it may modify the course of the disease. Again, you may give it in torpid cases to bring about a reaction when resolution will not take place rapidly enough, and you fear that there will be formation of tubercles. You may also use it in pneumonia with typhoid tendency, with slowness of speech, dry tongue, etc., and also at the later stage of pneumonia when the lungs refuse to return to their normal condition and you fear the breaking down of lung tissue. You hear all sorts of rales. Expectoration is muco-purulent, the patient has hectic type of fever, loses flesh, etc. Sulphur will save the patient. But you should not give it after tuber- 444 A CLINICAL MATERIA MEDICA. cles have formed. The proper remedy then is Lachesis. Sulphur is indicated only in the early stages of phthisis. It is seldom indicated in the advanced stages. But in the very incipiency, when you have an increase of blood in the chest, beginning dulness on percussion in the apex of either lung, diminished respiratory movement in the upper por- tion of the chest, Sulphur will, by equalizing the circulation, cure the case. In affections of the bowels we find Sulphur a very useful remedy. You may give it in diarrhoea when these characteristic symptoms are present: The stool changes frequently in color, at one time it is yellow, at another slimy, and at another watery. It may contain undigested food, especially in the case of scrofulous children. It is particularly worse in the morning, driving the patient out of bed. You may also use it in dysentery, particularly after the tenesmus has ceased, and mucus and blood are still being discharged. Respecting this early morning diarrhoea of Sulphur, it is necessary that you dis- tinguish several other remedies from it. In the first place, Bryonia, which is useful for early morning diar- rhoea, which comes on as soon as the patient begins to move about. Natrum sulphuricum is similar to Sulphur, and often requires to be used in scrofulous cases. That also has diarrhoea in the morning after getting up and moving about, but the stool is associated with a great deal of flatus. Another remedy is Rumex crispus, which has exactly the same symp- tom as Sulphur—early morning diarrhoea, hurrying the patient out of bed. But it is indicated after catarrhs, with the characteristic cough of Rumex. Still another remedy that is confused with Sulphur is Podophyllum. This has early morning diarrhoea, hurrying the patient out of bed. Jyike Sulphur, the stools are of a changeable color. It^differs ixom_Sulphur_ in that the diarrhoea continues through the whole day, although worse at noon. Then, too, with Sulphur you will almost always find the ten- dency to soreness and rawness of the anus. Phosphorus has morning diarrhoea, with green, painless stool. Dioscorea also has morning diarrhoea, but it is associated with grip- ing, colicky pains, pretty much of the same character as those calling for Colocynth, but they are apt to fly off to other parts of the body. I wish now to say a few words about the skin symptoms of Sul- phur. I have referred to them already in brief, so that I am only supplementing what has already been given to you. You will remem- SULPHUR. 445 ber that the skin is apt to be harsh, rough, coarse, and measly in the genuine Sulphur patient. There is very little tendency to perspira- tion, or if there is perspiration,«it is only partial, and then offensive, sour, or musty. There is tendency to the formation of acne, princi- pally on the face. Pustules form here and there over the body, which heal very slowly, indeed. Freckles are spread plentifully over the face, hands, and arms. There is also a tendency to intertrigo; sore- ness and rawness appear wherever there is a fold of skin, in the groin, mammae, or axillae, or in the folds of the neck. We find Sulphur indicated in that affection known as itch. Now, Hahnemann was the author of the theory that if itch was suppressed by external salves, as by sulphur ointment, that there will appear in consequence many other diseases. He cited hundreds of cases to prove his assertions. Some years after this announcement a Corsican found the little sarcoptis homines burrowing beneath the skin and laying its eggs in these burrows. He showed this to be the cause of the itch, and then thought he had effected the complete destruction of the psora theory. But there is another side of the story. A man who is a victim of the " itch " goes along the street and meets two friends, A. and B., with both of whom he shakes hands, and A. contracts the disease while B. escapes. Now, there must be a difference in the constitutions of these individuals, or they both would have taken the itch or both escaped it, for they were both exposed to the same extraneous influences. A.'s system must have been unsound or he could not have taken it, for the itch insect cannot find a suitable dwelling-place in a healthy organiza- tion. So, after all, the Corsican's discovery did not overthrow Hahne- mann's psoric theory. The term psora is an unfortunate one, but it serves to indicate the constitution which favors the growth of the sarcoptis. Sulphur is a valuable remedy in this affection, because the symp- toms of this disease belong to it. It has itching in the bends of the joints and between the fingers as soon as the patient gets warm in bed. The skin becomes rough and scaly, and little vesicles form. As the disease progresses, you find occasional pustules appearing here and there over the eruption. Now, in order to rid your patient of this sarcoptis, wash the parts thoroughly in warm water with soap, and then have him rub the skin thoroughly with a common crash towel. Then apply the oil of lavender, which will kill both the eggs and the fully-developed insect without suppressing the disease. Then you may 446 A CLINICAL MATERIA MEDICA. give Sulphur internally. If Sulphur has been used externally and the itch suppressed, you may have other remedies to choose from. Give Mercurius when pustulous and .eczematous eruptions complicate the case. You may give Sepia, particularly when constitutional symptoms appear. There are occasional large and well-formed pustules, which develop into an impetigo. Causticum is especially useful when itch has been suppressed by oint- ments of either mercury or sulphur. I next wish to say a few words about the action of Sulphur on the digestive apparatus. Sulphur is useful in disorders of the stomach, liver and intestinal canal. It may be indicated in dyspepsias of many varieties. The particular indications of the drug may be set down as these: First, in a general way, you find it indicated in patients who suffer from abdominal plethora or passive congestion of the portal system, as indicated by a sensation of tightness or fulness in the abdo- men, with feeling of repletion after partaking of but a small quantity of food. The liver is congested, enlarged and sore on pressure. The bowels are constipated, with frequent ineffectual urging to stool, and w7ith haemorrhoids which are the direct result of this abdominal ple- thora. Constipation frequently alternates with the diarrhoea. In these cases the diarrhoea is not apt to be the early morning diarrhoea of Sulphur. This remedy may also be the remedy for gastric ailments arising from the suppression of an eruption, whether that be erysipelas, eczema, itch or the like. Dyspepsia of drunkards, after excessive use of brandy and beer rather than wines, sometimes calls for Sulphur. Here, too, you often find the enlarged or congested liver. Sulphur is also indicated in dyspepsia from farinaceous food. It seems as if in every case of disease of the liver in which Sulphur is in- dicated, the patient cannot digest farinaceous food, which calls upon the pancreatic juice and bile as well as upon the gastric juice itself. The patient vomits a great deal. He cannot take any milk. If he attempts to do so he vomits it at once. That is a common symptom, you know, in drunkards. The vomited matters are apt to be sour and mixed with undigested food. In addition to these symptoms you find all sorts of abnormalities of appetite. The patient is hungry at ten or eleven o'clock in the forenoon, even after eating a moderate breakfast. He has goneness, faintness or gnawing feeling in the epigastrium, as if he must have food or sink. When he gets the food and relieves his sulphur. 447 hunger, he begins to feel puffed up. He feels heavy and sluggish, and so low-spirited that he scarcely cares to live. It will be well to remem- ber that Sulphur is indicated not so much in the beginning of these af- fections as after Nux vomica. You find almost exactly the same symp- toms under Nux. When that remedy only partially relieves, Sulphur comes in to complete the cure. Lachesis should be used in the enlarged liver of drunkards when the case has gone on to a low grade of symptoms, especially if inflammation ensues and abscess forms in the liver. If the liver wastes away, secondarily to the congestion, we must de- pend upon the other remedies, the most important of which are Phos- phorus and Laurocerasus. Next, a word or two in regard to Sulphur in diseases of the sexual organs. There is a trio of medicines, Nux vomica, Sulphur and Cal- carea, w7hich are useful in cases of masturbation and excessive venery. Beginning with Nux you note some improvement in the patient; by and by you will find symptoms of Sulphur presenting themselves. If Sulphur fails after producing partial relief, Calcarea completes the cure. The symptoms calling for Sulphur are these: You will find the patient weak and debilitated, having many of the gastric ailments that I have mentioned, particularly faintness, flushes of heat, cold feet and heat on the top of the head. There is frequent involuntary emission of semen at night, exhausting him the next morning. The seminal flow is thin and watery, and almost inodorous, and has lost all its characteristic properties, being nothing more than a shadow of the normal seminal secretion. The genital organs are relaxed; the scrotum and testicles hang flabbily; the penis is cold, and erections are few and far between. If coitus is attempted, semen escapes too soon, almost at the first con- tact. The patient suffers from backache and weakness of the limbs, so that he can scarcely walk. He is, of course, low-spirited and hypo- chondriacal. You may find Sulphur indicated in gonorrhoea, whether the discharge be thick and purulent, or thin and watery, when there are burning and smarting during urination, and when there is this bright redness of the lips of the meatus urinarius. Sulphur may also be used when phimosis occurs, especially when there is inflammation and induration of the prepuce. Sulphur also acts on the female genital organs. The main symptoms it produces are those which come from congestion of these organs. They are associated with flushes of heat and abdominal plethora; there 448 A CLINICAL MATERIA MEDICA. are bearing down and weight in the uterine region, a feeling of fulness and heaviness there, standing is a very annoying position to her, and there is burning in the vagina, often in association with pruritus and appearance of papules on the mons veneris. The nearest remedy to Sulphur here is Aloes, which produces pre- cisely the same symptoms, the same bearing down, the same fulness of the abdomen from abdominal plethora. Sulphur has, in addition to the above symptoms, aversion to washing. Aloes acts more on the rectum than on any other portion of the alimentary tract. There is a constant desire for stool. When stool is expelled it is accompanied by a great deal of flatus. The haemorrhoids of Aloes protrude like bunches of grapes, and are always relieved by cold water. In closing my remarks on Sulphur, I want to mention two or three uses you can make of the crude article. Sulphur has in its totality of symptoms a perfect picture of cholera Asiatica. It suits the incip- ient symptoms. It bears a resemblance to the course of the disease, and also to the subsequent symptoms. We have, then, in Sulphur a true prophylactic of that dreaded epidemic. It may be used by placing a little flowers of sulphur inside of the stockings. This sulphur is absorbed, as shown by the exhalation of sulphuretted hydrogen with the sweat. Flowers of sulphur burnt in a closed room may be used as a disin- fectant. LECTURE XLV. THE CARBON GROUP. Carbo animalis (contains phosphate of lime). Carbo vegetabilis (contains carbonate of potash). Graphites (contains iron). Aniline sulphate. Carboneum (Lampblack). Coal gas. Bisulphide of Carbon. I invite your attention this morning to the medicines obtained from the carbon group. Carbon in its purity is found only in the diamond. We have it comparatively pure, however, in the lampblack, or Carbo- neum. Carbon will necessarily be somewhat different in its action, according to the source from which we obtained it. Hahnemann used principally three carbons, Carbo animalis, Carbo vegetabilis and Graph- ites. The first he derived from the animal kingdom, the second from the vegetable, w7hile the last was an artificial product found principally lining the interior of large iron retorts. Carbo animalis is obtained principally from bones. It contains some phosphate of lime. Carbo veg. contains some carbonate of potash. It is obtained principally from a variety of the beech-tree. Graphites is always contaminated with more or less iron. Hence you see that these are not pure carbons. I have also placed on the board the Sulphate of Aniline, which behaves like a carbon and is a carbonaceous compound. Then, too, we have Carboneum and Carbonic oxide. Carbonic acid gas does not seem to possess active medicinal properties. It is not very poisonous. Its main deleterious effects are due to deprivation of oxygen. Carbonic oxide is much more poisonous, producing death, not only by suffocation, by displacing the needed oxygen, but by another remarkable peculiarity. It has the property or peculiarity of displacing oxygen from the blood and taking its place there. You know that oxygen is carried along in the blood by the red corpuscles. Carbonic oxide has the power of supplanting the oxygen in these structures. For a time, it seems to act like oxygen, but soon its poisonous properties are manifested with 29 45° A CLINICAL MATERIA MEDICA. all the inevitable results of asphyxia. Coal gas, which we obtain by slow combustion of coal, and the illuminating gas used in our large cities, are of this character. They produce serious effects when taken in large quantities, especially when the subject is deprived of the ordi- nary atmosphere. It is said that this coal gas is beneficial in the treat- ment of whooping-cough. I have known of but one case thus treated, and that one died. Bisulphide of Carbon, which has also been proved, has some valuable symptoms. Now, all of the carbonaceous substances have some properties in common. For instance, they all have a tendency to relieve putrescence or putrid discharges or putrid exhalations from the body and offensive sores. You all know the mechanical properties of charcoal, w7hat an absorbent it is, and how it can purify the atmosphere or substances that are undergoing decomposition. The animal charcoal, which is more porous, is here more effectual than the vegetable. If you bury a dead rat or mouse in charcoal for several months, you will not find any odor from the animal at the end of that time, but only a clean white skeleton. But this property, I would have you know, is not entirely mechanical. In the potencies, this property may be seen in the human system. Now I do not mean to say that potentized char- coal will prevent the odor from a decomposing animal, but I do say, that in a potentized state it exerts similar effects on the human sys- tem. All the carbons act also on the skin-producing excoriations of the skin and intertrigo. They affect the glands also, causing enlargement and induration of the'axillary and other lymphatic glands, even as in the case of Carbo veg. and Carbo animalis, cancerous enlargement and infiltration. They all effect the mucous membranes, producing catarrhs of the nose, throat and lungs, and also of the bowels. They all tend to produce asphyxia. We find this prominently in Carbo veg., less so in the Carbo animalis, and very marked in Aniline and Carboneum. Carboneum may produce asphyxia with convulsions simulating those of epilepsy. Coal gas and Carbonic oxide, too, are calculated to pro- duce dyspnoea from deprivation of oxygen. We find, also, that all the carbons act on the veins, producing varicose veins. We find, too, that all the carbons tend to produce flatulence. This is one of the reasons why I object to toast as an article of diet for the sick Toast, when the bread is nicely dried through by gentle and continuous heat, is very beneficial, but when it is charred, it tends to produce flatulence. The flatus is offensive and has an odor like that of rotten eggs. CARBO VEGETABILIS. 451 Carbo veg. V V Kali c., Phos. Carbo Vegetabilis. ' Ars., China, Phos., Phos. ac. In collapse, Camph., Veratr. alb. Caust., Kali c, Sulph. Ant. tart., Ammon. c. Baryt. c, Mosch., Nitr. ac. Lauroc, Lach., Opium. Paralysis of lungs. Bry., Nux v., Puis., etc. As I have already intimated to you, Carbo veg. contains some car- bonate of potash. It is also a fact worthy of note that Kali carb. is complementary to Carbo veg., especially in lung and throat affections and also in dyspepsia. Carbo veg. is also complementary to Phos- phorus, here, too, in chest affections, in the throat more than anywhere else and, too, in excessive debility, particularly in the threatened paralysis of the whole system as a sequel to severe disease. The drug is antidoted by Arsenicum and by Camphor, and holds an inimical re- lation with Causticum. The inimical relation between Carbo veg. and Causticum is not so marked as that between the latter remedy and Phosphorus. Carbo veg. is especially indicated in patients who are advanced in life, and, consequently, debilitated. It is called for in weak, delicate per- sons who are old dyspeptics, especially if they have abused their digestive organs by debauchery. In analyzing the drug, we will speak first of its effects on the blood. We find Carbo veg. indicated in affections in which the blood is de- cidedly changed, its composition altered. There is decided sepsis or blood poisoning in many of the diseases in which Carbo veg. is the remedy. We find the drug indicated in haemorrhages, haemorrhages, too, of a very low type. Thus we give it in epistaxis or nose-bleed when the face is pale and sunken and almost hippocratic. The blood flows persistently for hours, perhaps for days. It is dark and rather fluid. It is apt to occur in old and rather debilitated persons and dur- ing the course of diphtheria. You find nearly the same symptoms under Camphor and Mercurius cyanatus. We also find Carbo veg. indicated in haemmorrhages from the lungs, not only in haemoptysis, but also in bronchorrhagia. In these cases you will find the patient suffering from great anxiety and yet without 452 A CLINICAL MATERIA MEDICA. any particular restlessness. The anxiety is very evident in the face and in the efforts at breathing, but there is no particular restless tossing about. The patient complains of burning pain in the chest. Carbo veg. is to be used especially in far advanced cases of lung degeneration. The pulse in these cases is apt to be intermittent and thready. The face is pale and often covered with cold sweat. The patient wants to be fanned, because fanning brings more air to the lungs. These same symptoms indicate Carbo veg. in haemorrhages from the uterus, whether metrorrhagia or menorrhagia. Here, however, you find burning pains marked, burning across the sacrum and lower por- tion of the spine. If the haemorrhage continues any length of time you will notice the same trouble in the chest, with the difficulty in breathing above mentioned. Carbo veg., you will find here, will work hand in hand with Cinchona and Arsenicum. Arsenicum is useful in these persistent haemorrhages of a low type, depending upon some degeneration in the organ affected. Both it and Carbo veg. have these violent burning pains. With the Arsenicum, however, you have, as a distinction which applies all through, irritability of fibre and mind, too, which is not the case w7ith Carbo veg. Carbo veg. is a torpid, sluggish remedy, while Arsenicum has irritability, with restless tossing about, anxiety, etc. Ipecacuanha should also be remembered in haemorrhages, especially in haemorrhages from the lungs and uterine haemorrhages, when the patient takes long breaths, as if panting. Unless there is present a cold stage, amounting almost to collapse, you may prefer to begin with it rather than with Carbo veg. or Cinchona. Next wre find Carbo veg. useful in varicose veins which occur on either the arms or legs, or even on the female genital organs. These varicose veins tend to ulceration. Now you will find these varices bluish or livid, looking as though the blood had long remained in them. In these varicose ulcers you will find very similar symptoms to those in other ulcers in which Carbo veg. is the remedy; burning pains, mottled appearance of the skin around the ulcer as though the smaller capillaries had become enlarged. Ecchymoses are seen beneath the skin. The ulcers have a decidedly indolent appearance. Carbo veg. is also useful in ulcers other than varicose when they are of a very low type. They are flat ulcers, tending rather to spread on the surface than to dip deeply into the parenchyma of an organ. They discharge not a healthy pus, but instead, that which is ichorous, corrosive, thin, burning and offensive in character. The burning is CARBO VEGETABILIS. 453 worse at night, depriving the patient of sleep and keeping him in tor- ture the whole night. Even in cancerous ulcers, in ulcerating scirrhus, you will find Carbo veg. useful. It may also be administered in carbuncle, particularly when the af- fected parts are bluish or livid, and when the discharges are offensive and associated with burning pains. In these cases it is not only your duty to give it internally, but also to apply it externally as a plaster. It tends to prevent decomposition of fluids, sweetens the sore and so prevents poisoning of the system. The same is true for gangrene. When carbuncles or boils become gangrenous, Carbo veg. may be indi- cated. In these cases it is distinguished from Arsenicum by the absence of this extreme restlessness. In febrile conditions, Carbo veg. is useful for the typhoid and inter- mittent types of fever, for collapse during fever, and for yellow fever. It is a preventive of yellow fever just as Sulphur is of cholera. If all the ejecta of the patient are buried in charcoal, the spread of the dis- ease is sure to be prevented. When the disease is fully established, Carbo veg. would be of no more use than would Sulphur during the course of cholera. The intermittent type of fever in which you may employ Carbo veg. is of a low7 grade. The case is one of long-standing, and has been abused by quinine. There is thirst during the chill. The feet are icy- cold up to the knees. That is a very characteristic symptom of Carbo veg. {Menyanthes is the remedy in quartan fever when the legs below the knees are icy-cold.) When the heat comes, it is in burning flashes. The sweat is either sour or else exceedingly offensive from alterations in the discharges of the skin. During the apyrexia the patient is pale and weak. Memory is weak; the mind seems to be befogged. The patient is decidedly low-spirited and melancholy. In the hectic type of fever, Carbo veg. is indicated by pretty much the same symptoms as those which I have already mentioned. It is particularly useful for hectic fever dependent upon long-lasting suppu- ration, whether due to abscess in the lungs, or in the hip-joint, or about the vertebrae. You know that abscesses accompanying diseases of the spine may have to be opened. Sometimes surgeons are afraid to do this before they have prepared the system for it, because reaction is so slow that the patient may be made worse by it. The danger from opening these abscesses may be greatly lessened by the use of Carbo veg. or Cin- chona. 454 A CLINICAL MATERIA MEDICA. In collapse from various causes you may use Carbo veg. There is decided lack of animal heat. The nose, cheeks and extremities are cold. The breath even may be cold. It is indicated in the late stages of typhoid fever; after protracted loss of vital fluids, as after long-lasting haemorrhages; during cholera Asiatica; during pneumonia; and, in fact, in any form of disease in which these symptoms appear. The body seems to be icy-cold, especially about the extremities; the breath is cool; the pulse is thread-like, scarcely perceptible and intermittent. The lips may be bluish from cyanosis. Breathing is very weak and superficial ; the patient may be either conscious or unconscious. Now, Carbo veg. in just such cases comes in as a savior, and rescues many a case that would otherwise die. There are other remedies similar to Carbo veg. in collapse. Camphor, especially, is similar to it in cholera Asiatica, but it is rather indicated in the beginning of cholera without any vomiting or diarrhoea, when the poison seems to have depressed or shocked the nervous system, so that the patient is icy-cold, dry or in a cold sweat; the tongue is cold. If he can speak, it is in a squeaky or in a high-pitched voice, or else it is a husky, toneless voice. Camphor, in such cases, brings about reaction very quickly. Carbo veg. would be indicated in the later stage, when the prostration is the result of the drain on the system by the alvine discharges. Veratrum album is also similar to Carbo veg. in collapse. It has cramps in the calves of the legs, the thighs and chest, and characteris- tically cold sweat on the forehead. I wish next to say a word about Carbo veg. for its action on glands. The glands, especially the mammae, become indurated. There are burning pains in the swollen glands, with tendency to suppuration. When they do suppurate, the discharged pus is not of a laudable char- acter. We find Carbo veg. indicated in catarrhal troubles which are pro- voked by warm, moist atmosphere, such as we have in this latitude with southwest or southerly winds. The patient is worse in the evening. He has aphonia recurring regularly each evening, painless or associated with raw feeling down the larynx and trachea. There is dry tickling cough, at times quite spasmodic in its character. It is here analogous to Phosphorus, and is often preceded or followed by that remedy. The Phosphorus aphonia is associated with rawness of the larynx, and is worse in the evening. CARBO VEGETABILIS. 455 In the morning aphonia, Carbo veg. is more closely allied to Sulphur, which has loss of voice, particularly in the morning. Still another concordant remedy of Carbo veg. is Causticum, which is suited to laryngeal catarrh in singers with rough hoarse voice, and associated with tracheo-bronchial catarrh, with rawness and burning under the sternum. This is found under both remedies. The main difference is that Causticum has hoarseness worse in the morning, and Carbo veg. in the evening. Causticum has aggravation in dry, cold weather, and Carbo veg. in a damp, warm atmosphere. Another remedy is Eupatorium perfoliatum, which I use for hoarse- ness with soreness in the larynx, trachea and bronchial tubes, too. The hoarseness is worse in the morning, and is apt to be associated with pains all over the body. Carbo veg. may also be used in asthma, particularly in the asthma of old people and of people who are very much debilitated. They look, during the asthmatic attack, as if they would die, so oppressed are they for breath. They are greatly relieved by belching wind. It is espe- cially indicated in asthma which is reflex from accumulation of flatus in the abdomen. It may also be used in threatening paralysis of the lungs in typhoid fever, after pneumonia, and in old people. The "paralytic catarrh" of old people calls for Carbo veg. There are loose rattling rales when the patient coughs or breathes, a marked symptom of emphysema. The bronchial tubes are greatly dilated. In addition to this you will find coldness, symptoms of collapse, etc. The nearest approach to Carbo veg. in emphysema is Ammonium carb., which, like Carbo veg., has blood poisoned by carbonic acid, giving you the coldness, blueness, etc., incident to that condition. In threatening paralysis of the lungs, we have a great many reme- dies to consider, most of which I will reserve until we come to speak of Phosphorus, which stands very close to Carbo veg. Then, too, you should also remember Moschus and Antimonium tartaricum. Antimonium tartaricum applies when there are loud rales heard in the chest. It seems as if there was an immense amount of mucus there. The patient can scarcely raise any phlegm. The extremities are cold and blue from the cyanosis developed by the blood poisoning. The patient soon becomes drowsy and passes into a stupor from which he can be aroused, but into which he readily relapses. You should also remember Antimonium tartaricum when, in the course of lung affections, whether there be bronchiectasia or catarrh on the chest in 456 A CLINICAL MATERIA MEDICA. children (and here it is especially called for), the cough ceases or be- comes more rare and yet there is no diminution in the mucus-pro- duction itself. Your practiced ear placed on the chest detects just as much oppression of the chest, just as copious an exudation, and just as much rattling of phlegm in the lungs, and yet the child does not cough so frequently. The mother thinks the child is better. But in reality the child is worse, for the lungs are losing their power. Carbo veg. is an excellent remedy for the terrible dyspnoea of chronic aortitis, especially when the patient has become very anaemic, dropsical, etc. Here you should compare Arsenicum. Cuprum and Lachesis. Still further, I want to speak of the action of Carbo veg. on the stomach and bowels. We find it here, rivalling other well-known remedies in dyspepsia or indigestion, and those of a rather low type, too. We find it indicated, too, for the bad effects of debauchery, for excessive indulgence in table luxuries, and for bad effects from wines and liquors and all kinds of dissipation. As a result of dissipation, we may have just such symptoms as call for Carbo veg.; headache, par- ticularly in the morning when the patient awakes from sleep, having spent the best part of the night carousing; dull headache referred to the back part of the head, with a great deal of confusion of mind. There is humming or buzzing in the head as though a hornet's nest had taken its place there. The patient feels worse in the warm room. The pain also seems to go from the occiput through the head and into and over the eyes, giving a dull heavy aching in that region. There are nausea and weakness referred to the stomach, usually a burning sort of distress referred to the epigastrium. He is unable to take any fat food, whether meat, gravy or fried food. He cannot drink milk because it produces flatulence. The stomach feels heavy, as if it were dragged down after eating. The abdomen is distended with flatus. Both belchings and borborygmi are offensive. The wind belched has a rancid taste. Sometimes it has a putrid taste and a decidedly offen- sive odor when passed from the bowels. He suffers from constipation with piles. The piles get worse every time he is on a spree; oozing of moisture from anus; perineum, sore, itching.* Sometimes they protrude and are bluish, they are so distended with blood. At other * Perineum, moist, raw, oozing, etc.; Atnmon. c, Alum, Natr. m., CARBO V., Carbo A., NlfR. AC, Graph (and cracked), Sulph., Rhus tox., Arsenic, Ant. CR. (mucous piles), THUJA (offensive oozing), SILICEA (moist), Sulphuric acid', Capsic, Petroleum (see also Fissures), Borax (slimy, purulent oozing); Sepia (oozing). CARBO VEGETABILIS. 457 times, he has morning diarrhoea with stool which is watery and thin and accompanied by a great deal of straining. We find Carbo veg. par- ticularly indicated here after the failure of Nux vomica. The patient is peevish, easily angered. Vertigo reflex from the gastric disturbance is present. It is especially worse after a debauch and after excessive in- dulgence in high living. It is often associated with syncope, especially at meals or after eating. The nearest concordant remedy here is Arsenicum. Both remedies have bluish protruding piles, both have burning in the epigastrium, both have anxiety, and both have ailments after the excessive use of liquors, and both, are suited for the bad effects of ice-cream, and ice- water in hot weather. The difference between the remedies may be expressed in these few words: Carbo veg. is torpid, Arsenicum is always irritable; of the two remedies, Carbo veg. has the burning most marked especially in internal parts, as in the stomach. Nux vomica impinges on Carbo veg. in the bad effects of over-eating and high living. As I have already said, Carbo veg. comes in when Nux has ceased to act. The Nux toper is a thin, spare, yellow, wiry, fellow. That of Carbo veg. is sluggish, stout and lazy. Next we are to distinguish Carbo veg. from Cinchona. That ought to be easily done, because the two drugs meet only in the flatulent dyspepsia and in debility. Cinchona is suited to a peculiar functional debility, when the system is devitalized by loss of animal fluids Carbo veg. is the better remedy when the debility arises from organic causes, when we have a picture of collapse with hippocratic face and coldness of the body, particularly of the knees. This last is an excellent indi- cating symptom for Carbo veg. It may occur in almost any disease. Both remedies produce great flatulence. Cinchona, however, does not have this rancid belching with burning. Belching temporarily relieves the symptoms. Lycopodium also typifies perfectly this state of tympanites. The abdomen is enormously distended. The distinction to be made between it and Carbo veg. is this: Carbo veg. produces more flatulence of the bowels, Lycopodium more of the stomach. Again, Carbo veg. pro- duces rancid belching or else passage of offensive flatus with bitter taste in the mouth. Lycopodium has more of a sour taste with its belching. Carbo veg. may be indicated in dysentery. Here it is called for in very severe cases. There are burning pains situated deep in the abdomen, usually in one or the other of the bends of the colon. The abdomen is greatly distended and tympanitic. The pulse is weak 458 A CLINICAL MATERIA MEDICA. and intermittent. The discharges from the bowels are horribly offen- sive and brown, watery and' slimy in appearance. You see what a desperate case we have here, one that calls for great skill in prescrib- ing. You must distinguish between two other remedies and Carbo veg. These are Arsenicum and Cinchona. Arsenicum helps when there is, as I have said, that irritability of fibre. The patients are just as sick and just as near death's door as is the Carbo veg. patient, but they are restless, and complain of burning thirst and yet have an intolerance of water. The discharges from the bowels are about the same in character under the two remedies. Ar- senic, however, has not such marked tympanitic distension of the abdomen. Cinchona and Carbo veg. are also similar in these cases. Both have these dark offensive fluid discharges, both have the distension of the abdomen, both have great weakness and hippocratic face. With Cin- chona, however, the movements from the bowels are provoked by every attempt to eat or drink. Belching gives but temporary relief. Again, the flatus is not so offensive as with Carbo veg., nor are the burning pains so marked as under Carbo veg. or Arsenicum. LECTURE XLVI. CARBO ANIMALIS, GRAPHITES AN® PETROLEUM Carbo Animalis. Carbo animalis. V Calc. phos. Bromine. Sepia, Natr. m. Silic, Phos. Badiaga. v Merc. iod., Nitr. ac Carbo animalis and Carbo veg. do not follow each other well. They are so far inimical that one may not be given with benefit after the other. They are too nearly the same. Carbo animalis contains some phosphate of lime. Carbo animalis is complementary to Calcarea phos- phorica, especially in affections of the glands. Carbo animalis is suited to old persons and to those who are greatly debilitated by disease, particularly when there is a predominance of what is known as venous plethora. You find such patients particularly inclined to blueness of the skin. The hands and feet readily become blue, with distended veins showing through the skin. They become ill from very slight causes. The cheeks often get bluish. Both it and Carbo veg. are indicated in decomposition in certain parts of the body, as in gangrene and ulcerations of the surface or of internal parts, with putrid discharges. Both, too, are indicated in weakness of the digestive organs, both are indicated for the bad effects of loss of animal fluids, particularly during lactation. Now, as a general distinction between the two drugs, you may re- member this: Although both drugs acton the glands, the predominance is in favor of the Carbo animalis for glandular affections. For instance, we find it indicated in induration of glands, of the axillary glands and of the glands in the groin, particularly in syphilitic or gonorrhoeal patients. These buboes are hard like stone; Carbo animalis is especially useful when these have been opened too soon, and when there is a gaping 460 A CLINICAL MATERIA MEDICA. wound which has partly healed, leaving the surrounding tissues of an almost stony hardness. Badiaga rivals Carbo animalis in just these cases, particularly in indurated buboes that have been maltreated. Again, we find Carbo animalis indicated in cancer more frequently than Carbo veg.; particularly is it useful in cancer of the breast or of the uterus. In mammary cancer you have the gland indurated in little nodes; a small circumscribed portion of it is as hard as a stone. Later the skin around the induration becomes bluish and mottled, thus show- ing you the characteristic effect of Carbo animalis in producing venous stasis. The axillary glands on the affected side become indurated and there are burning, drawing pains through the mammae. In the case of cancer of the uterus there are induration of the cervix, metrorrhagia, and burning pains extending down the thighs, and thin, offensive vaginal discharge. In affections of the digestive organs, Carbo animalis differs from Carbo veg. in this: We find that under Carbo animalis there is goneness and empty feeling in the pit of the stomach, not relieved by eating, and in this respect it is very similar to Sepia. We find these symptoms indicating Carbo animalis preferably to Carbo veg. in the weakness of nursing women; we notice that every particle of food taken distresses the stomach, just as we found under Carbo veg., but with Carbo animalis there is coldness about the stomach, which is relieved by pressing firmly with the hand or by friction over the abdomen, thus showing you the weak debilitated condition in which the patient is, w7ho requires this remedy. Carbo veg. has dragging heaviness about the stomach to distinguish it. Both remedies have piles with this weak digestion, but there is oozing of a thin, inodorous fluid from the rectum in Carbo animalis which does not exist markedly under Carbo veg. Both drugs meet again in affections of the chest. We find them both indicated in the late stages of pneumonia, bronchitis, or of phthisis pul- monalis, when there is destruction of the lung tissue and decomposition of the fluid which is expectorated. It is just here that you are most liable to make a mistake in selecting one drug for the other. Carbo animalis has this symptom to distinguish it, suffocating hoarse cough producing shaking of the brain as though the brain were loose in the head. There is a cold feeling in the chest. {Bromine has that sensation also.) Expectoration is green, purulent and horribly offen- sive, and comes generally from the right lung, in which you will find CARBO ANIMALIS. 461 by examination, a cavity. As soon as the patient closes his eyes he feels as if he were smothering. The Carbo veg. cough is spasmodic, with deep, rough voice or else with aphonia. There is decided burning in the chest and expectoration is profuse, particularly in the bronchitis of old people. It is yellow and very foetid, more so than in Carbo animalis. The patient has dyspnoea, worse on turning over in bed and on dropping off to sleep. There is a great deal of rattling in the chest. Carbo animalis is more useful than Carbo veg. in constitutional syphilis, and for this reason : While both may be indicated in consti- tutional or tertiary syphilis, after the abuse of mercury, particularly when the glands are affected, and there is great emaciation, Carbo animalis is indicated more by these symptoms: It has coppery-red blotches on the skin, particularly on the face. That you know to be the characteristic hue of syphilitic eruptions. In this respect it re- sembles Mercurius bin., Nitric acid and Badiaga more than it does Carbo veg. In debility, we find Carbo veg. always superior to Carbo animalis. We find very few characteristic symptoms indicating the latter as a remedy in the last stages of typhoid fever, pneumonia and scarlatina. The only difficulty you will have in deciding between the two drugs will be in the debility attendant upon lactation. In affections of the ears we find Carbo veg. and Carbo animalis again meeting. Thus, we find both drugs causing otorrhcea. The discharge is thin, ichorous, bloody and excoriating in both remedies. With Carbo animalis there is also associated a swelling of the perios- teum behind the ears over the mastoid process. Here it is similar to Nitric acid, Aurum and Capsicum. With Carbo veg. we find this otorrhoea particularly as a sequel to exanthematous diseases, as measles and scarlatina. There .is no swelling of the periosteum back of the ear. Both remedies are indicated in deafness. Carbo animalis has this peculiar symptom: They cannot tell whence sound comes. Carbo veg. is indicated in deafness when the ears are too dry from the absence of the cerumen or wax, or when there is discharge of offensive ceru- men. In eye affections we find Carbo animalis indicated when the patient is far-sighted; while walking along the street objects seem to him to be far off. The eyes seem as if they were loose in their sockets. This feeling is due to relaxation in the connective tissue similar to that found 462 A CLINICAL MATERIA MEDICA. in the brain. Old people have dimness of sight on attempting to read, but this is relieved by rubbing the eyes. Carbo veg. is indicated when the patient is near-sighted ; objects have to be placed near to the eye to be seen. This symptom is worse after exerting the eyes or after using them steadily for any length of time. Graphites. Graphites. V Arsenicum. V Ferrum. Graphites. < Sepia, Pulsatilla. Kali carb., Phosphorus, Calcarea ostr. Sulphur, Lycopodium, Silicea, Hepar. Phytolacca. Mezereurn, Petroleum, Iris, Rhus. Mercurius, Antimon. crudum. Staphisagria. i Ratanhia, Paeonia, Nitric acid. Slight erethism ; then weak, relaxed, anaemic ; chlorotic Fat, chilly, costive ; lymphatic glands swollen. Skin: Cracked, rhagades, fissures, herpes, eczema, oozing of scanty gluey humor. Cicatrices are softened. Mucous membranes : Scanty secretion,cracks,fissures,etc. Graphites is not a pure carbon. Even the purest specimens of it contain some iron. You will note that I have placed beneath it two complements, namely, Arsenicum and Ferrum. It has many symp- toms in common with Ferrum, acting complementary to that drug, and many more allying it to Arsenicum. It is a relative of Ferrum, principally in this class of symptoms, par- ticularly in anaemia or chlorosis of females. There are irregularities in the distribution of the blood, and pallor of both skin and mucous mem- branes. It is complementary to Arsenic in many of the skin symptoms, in affections of the glands, burning in internal parts, and other symptoms akin to it. Besides these complementary remedies, Graphites has quite a number of concordant remedies. It is antidoted by Arsenicum, and in some of its gastric symptoms by Nux vomica. Arsenicum, you thus see, holds two relations to Graphites; one of antidote and one of complement. It is complementary in one series of effects, and anti- dotal in another. Arsenicum antidotes especially the mental symptoms of Graphites. GRAPHITES. 463 The Graphites patient is sad and full of grief, particularly if a female. She has an anxious, apprehensive state of mind, which com- pels her to move about from place to place. She has forebodings of some imaginary accident or mishap which is about to take place; it makes her anxious and restless; she cannot be kept quiet. It is this group of symptoms which Arsenicum antidotes. We find this anxious, apprehensive state of mind in Graphites to be a very important symp- tom. You all know how important in making a homoeopathic pre- scription the mental symptoms are. We find this apprehensiveness, this low-spiritedness, qualifying many of the Graphites conditions. We see it in the chlorosis, in the skin symptoms, in the inflammations of the eye, etc., as you will discover later on. The circulation is at first excited, followed by loss of energy and consequent venous hyper- aemia. Syncope readily occurs, with great anxiety. Motion is im- paired and tissues are relaxed, but paralysis is not complete. We find Graphites acting best in constitutions in which there is a tendency to obesity. This obesity, I w7ould have you remember, is not a healthy, solid flesh, that belongs to a full-blooded, strong, hearty individual, but it is that kind of fat w7hich you find under Calcarea ostrearum, showing improper nutrition. We find the two remedies running close by each other in such fat but not healthy individuals. The Graphites constitution is also one in which there is deficient animal heat, owing to the defective oxygenation of the blood. These patients are always cold, whether they are in or out of doors. In the case of chlorosis, the Graphites patient has these symptoms: There is a ten- dency to rush of blood to the head, with flushing of the face, just exactly similar to that which belongs to Ferrum. The patient feels a sudden shock about the heart, and this is followed by rush of blood to the head. She thinks she has heart disease. On lying down at night, the patient experiences throbbing all through the body. That is not due to true plethora. The blood is decidedly " watery," and, if you were to examine it microscopically you would find an excessive number of white blood corpuscles. The menstrual flow in these cases is too [late, too pale and too scanty. The mucous membranes are apt to be pale, just as you find under Ferrum. The lips will be pale. The patient suffers from leucorrhcea, which is watery and quite profuse, sometimes excoriating the parts over which it flows. NSw, you may say, how are we going to distinguish this from Pul- satilla f Like Graphites, Pulsatilla has late and scanty menses, with pale or dark flow in chlorotic or anaemic patients; also in patients who 464 A CLINICAL MATERIA MEDICA. are apt to be chilli y, and who are low-spirited, crying at every im- aginary trouble. How will you distinguish between these remedies ? The main distinction lies in this: The Graphites patient always has some skin symptoms to aid us, Pulsatilla scarcely any. The Graph- ites patient has a rough, harsh, dry skin, with very little tendency to sweat. Little pimples, whether containing pus or not, appear on the body, and are apt to be worse at the menstrual periods. While in Pulsatilla there is strong tendency to diarrhoea, in Graphites there is strong tendency to constipation. These symptoms are sufficient to always enable you to distinguish between these two closely allied remedies. Next, as most important in our study of Graphites, I wish to call your attention to the action of the remedy on the lymphatic glands, and also upon the skin. It produces enlargement of the lymphatic glands, of the neck and of the axillae, and also of the inguinal and of the mesenteric glands. This, together with marked skin symptoms, calls frequently for its use in scrofula. Now, we find it running par- allel with Calcarea ostrearum, Sulphur and Silicea in scrofulosis, par- ticularly of children. We find the abdomen large and hard. The children thus affected suffer from diarrhoea, with stools which are thin, offensive and contain partially digested food. In inflammation of the eyes, of a scrofulous character, we have no remedy, not even Calcarea, Sulphur ox Arsenic, that excels Graphites. The cornea is apt to be covered with superficial ulcers, or again, it may be inflamed. There is thickening of the eyelids, particularly along the edges, which are covered with scurf or scales. The lids may be agglutinated or not, but the grand characteristic which makes the choice of Graphites certain is this: The blepharitis is worse in the angles of the eye, in the canthi. There is tendency for the edges of the lids to crack and bleed. If that is present you need not hesitate to use Graphites. The thickening of the cartilages of the lids may be so great as to produce ectropion or entropion. Then, too, the eyelashes become wild, turn in towards the ball of the eye and irritate the conjunctiva. Hardened styes may appear along the edges of the lids. Graphites also affects the vision. Letters appear double and run together. An eczematous eruption appears about the eyes, on the cheeks, on and behind the ears, on the top of the head and down the occiput. It may also be scattered here and there over the surface of the body, particu- larly in the bends of the joints. Behind the ears it assumes the form of intertrigo, being moist and sticky. If the child lies on its ear, the GRAPHITES. 465 ear will be glued fast to the head. Sometimes you find Graphites indicated in phlyctenular ophthalmia. Little vesicles form on the cornea and on other parts of the eye, producing profuse, burning lachrymation. These tears are mixed with pus, which is thin, and excoriates the cheek over w7hich it flows. The discharge from the nose, which is partly from the eye by the way of the puncta lachrymali, is also thin and excoriating, and you find cracks and crusts around the nostrils quite in harmony with the condition of the borders of the eyelids. I would now like to mention briefly a few of the distinctions between Graphites and its allied remedies. Petroleum or coal-oil is similar to Graphites in many of its symptoms. It has an eruption very much like that of Graphites and is particularly indicated when the most marked symptom is an intertrigo behind the ears. If the child is old enough, he will also complain of aching and other painful symptoms in the back of the head. The main distinction between the two reme- dies is that Graphites pictures more of a herpes and Petroleum a pure eczema. In prescribing Calcarea ostrearum the local symptoms, particularly those of the eyes, do not help you much. They are too general. They are just the symptoms of scrofulous ophthalmia. But you would be aided in your selection of the drug by its general symptoms, sweat of the head and cold, damp feet (which are not prominent under Graph- ites). You may also remember that Calcarea ostrearum is the best remedy for the results of scrofulous ophthalmia, rather than the acute symptoms themselves. It is best suited to the opacities of the cornea and the thickening of the lids. Arsenicum has the same burning, excoriating discharge from the eyes, but is distinguished by this: The lids are spasmodically closed. Otherwise the symptoms are provokingly similar. Sulphur will help you when the edges of the lids are redder than natural, while under Graphites the edges of the lids are paler than they ought to be. Euphrasia is useful in phlyctenular ophthalmia with excoriating dis- charge, etc. But although the discharge is excoriating under Eu- phrasia it is thick and purulent, while it is thin under Graphites. Mercurius is also useful in scrofulous cases, especially when the patient is worse at night and from the heat and glare of the fire. Mer- cury is decidedly preferable if syphilis complicates scrofulosis. Hepar is very similar indeed to Graphites. It is preferable when 30 466 A CLINICAL MATERIA MEDICA. there is throbbing in and about the eye. Now if the child is not old enough to tell you if there is throbbing in and about the eye, you will notice that there is pain and you will see evidence of the formation of pus; for instance, suppurating styes form on the lids. Hepar suits the suppurative process better than does Graphites. You will also notice that the Hepar child will not allow anything to press on the eye> because the parts are so sensitive. Graphites is said to prevent the return of erysipelas when that dis- ease becomes constitutional. The affected parts feel hard and tough, and if it be the face that is involved, are very much distorted. There are burning, stinging pains, as we found under Apis. It usually com- mences on the right side and goes to the left. It is particularly useful when Iodine has been abused. Still further, you must remember the use of Graphites in the re- moval of cicatrices. This remedy seems to have the property of causing the absorption of cicatricial tissue. It was long ago noticed in workers in graphite, that wounds on the hands healed and the cicatrices disap- peared very rapidly. Dr. Guernsey has made use of this property of the drug for the removal of cicatrices that form after mammary abscess. Professor Korndcerfer greatly relieved a child's eye by the remedy. The child had been operated on, and cicatrices formed which contracted more than the surgeon expected they would. Graphites so far relieved the case that the parts assumed their normal position. We next have to speak of the action of Graphites on the digestive organs, and here it is allied particularly to the other carbons, Carbo veg. and Carbo animalis. We find the patient complaining of disagreeable taste in the mouth in the morning, as though he had been eating eggs. This symptom is more marked here than in any other carbon. The patient is worse from all meats. This symptom you find under Pul- satilla, Ferrum, and, in fact, under all chlorotic remedies. Sweet things nauseate and disgust the patient. After eating, the stomach becomes distended with wind. There is burning pain in the stomach; also a crampy, colicky pain—a real gastralgia, in fact. The patient wakes up at night gasping for breath; sudden dyspnoea, which is temporarily relieved by eating. The gastralgia is also relieved by eating. In this respect it again resembles Petroleum, which has gas- tralgia relieved by eating. The same symptoms you will also find under Chelidonium and Anacardium. The abdomen is greatly dis- tended from flatulence, and with this distended abdomen we have rush of blood to the head. The liver is apt to be hard and enlarged, with GRAPHITES. 467 extreme tenderness to the pressure of the clothing after eating. The bowels are usually constipated. The characteristic stool is this: The stools are covered with mucus or contain shreads of mucus. That is a very characteristic symptom of the Graphites. I think that it is also of Cascarilla. The patient suffers from haemorrhoids, which burn and sting; the anus is so extremely sore that the patient is very much an- noyed when sitting. Fissures form in the anus. Graphites is here one of our best remedies. Now we have several similar remedies here. First, Lycopodium. This has this distension after eating, with great accumulation of flatus, but this flatus is not rancid or putrid, as it is under Graphites. That is a sufficient distinction between the two remedies. Again, we have this list of remedies : Ratanhia, Pceonia, Nitric acid and Silicea. Ratanhia is an excellent remedy for fissure of the anus, and is to be recommended when there is great constriction of the anus. Stools are forced with great effort and the anus aches and burns for hours after stool. PcBonia is also useful for fissures of the anus with a great deal of ooz- ing, thus keeping the anus damp and disagreeable all the time. This is associated w7ith great soreness and smarting. Nitric acid is also a remedy for fissure of the anus, particularly when there is a feeling as if there were splinters or sticks pricking the anus. Now Graphites is distinguished from all these by the fact that they have more or less tenesmus or constriction of the anus, while Graphites has little or none. Silicea is also a remedy for fissure of the anus. The patient tries to force a stool, but it will not come out. The stool partly descends and then slips back again. Now the mucous membranes: Graphites is useful in nasal catarrh when there is extreme dryness of the nose. You often find this in scrofulous cases. This alternates with the discharge of lumps, or clinkers, as they are sometimes called. At other times, the discharge is very offensive and bloody. You notice how the offensive character of the discharge shows itself in these carbons. The borders of the nostrils are sore and scabby, and crack readily. Here you have a resemblance to Antimonium crudum, to Calcarea and to Arum tri- phyllum. The sense of smell is too acute. The patient cannot bear the odor of flowers. There is cracking or roaring in the ears when swal- lowing or chewing. This tells you that there is catarrh of the Eusta- chian tubes. On examining the ear with the speculum, you will find 468 A CLINICAL MATERIA MEDICA. the membrana tympani not perforated, but quite white. The ears are apt to be too dry, and there is a lack of natural secretion (just as you found under Carbo veg.), with hardness of hearing, better from riding in a carriage. It is not the riding that improves the hearing, but the noise made by the carriage. Graphites may also be used in chronic sore throat with sensation as of a lump in the throat. This is worse after empty swallowing. Here it is similar to Sulphur and Calcarea ostrearum. The cough of Graphites is not very characteristic. It is a dry cough with a great deal of strangling, making the face red and the eyes water. It is worse during deep inspiration. On the male genital organs, Graphites acts quite prominently. We find it producing uncontrollable sexual excitement and violent erections. The most important symptom of Graphites is impotence. There is a want of sensation during coition with no discharge of semen. It also acts on the female organs. We find affections of the left ovary with enlargement of that gland, and with scanty delayed menses, chilliness, constipation and coexistent eruptions. The uterus is dis- placed under Graphites. The os is far back and presses against the posterior wall of the vagina, hence the remedy is indicated in anteflexion and in anteversion. With this, there is bearing down extending into the hypogastrium. The leucorrhcea is watery and profuse, sometimes coming in gushes. Often, with these symptoms, there exists an ecze- matous eruption about the vulva. Petroleum. This is a highly carbonaceous oil, but it is not a pure carbon. Medi- cinally, it stands somewhat between Sulphur and Phosphorus on one hand, and Graphites and Carbo veg. on the other. We find that those who work in coal-oil are subject to eruptions on the skin. Thus a wheal appears across the face or body looking like a hive, and this itches and burns. Then, again, a vesicular eruption appears there which develops into a perfect picture of eczema, forming thick scabs and oozing pus. The skin soon grows more harsh and dry, and there form deep cracks and fissures which bleed and suppurate. These symp- toms make Petroleum an excellent remedy for eczema wherever it may appear. We find it useful in rhagades, particularly when they occur in winter, when the hands chap, crack and burn and itch intolerably. Sometimes, ulcers develop. PETROLEUM. 469 Again, Petroleum has been used in sprains of joints, especially in old rheumatic patients. It is particularly indicated in rheumatism, when the knees are stiff, this stiffness being associated with sharp sticking pains in them and with stiffness of the neck and cracking sounds when moving the head, owing to roughness of the muscular fibres. Next we find Petroleum to be remembered in diseases of the mucous membranes. It may be used successfully in ozaena. Here the dis- charge is quite in agreement with the character of the eruption. Scabs and purulent mucus are discharged from the nasal cavities. The nose is sore and the nostrils are cracked as in Graphites. The post-nasal space is filled with purulent mucus, causing hawking of phlegm. Then, too, we find the eyes affected under Petroleum. It is espe- cially useful in blepharitis marginalis. It is also indicated in inflam- mation of the lachrymal canal, when suppuration has commenced and a fistula has formed. This tendency to the formation of fistula is also seen in the gums, anus, etc. It is a general characteristic. The cough of Petroleum is also to be remembered. It is a dry teasing cough which comes on when lying down at night. We often find that cough in children with a diarrhoea which, however, appears only during the day. Next we find Petroleum affecting the sweat itself, producing profuse offensive sweat in the axilla and on the soles of the feet. The only chest symptom of Petroleum is cold feeling about the heart. This symptom is strong under Natrum mur., which has it very well-marked, especially when exerting the mind. It is also found under Kali chloricum, Graphites and Kali nitricum. Next we look to Petroleum in its action on the stomach and bowels. It produces nausea and vertigo with vomiting of bile, worse in the morning, worse from riding in a carriage and worse during pregnancy. Then, too, Petroleum is useful in sea-sickness. Petroleum produces a diarrhoea which is somewhat akin to that of Sulphur. The stools are offensive and watery, and often contain un- digested food. They come early in the morning and are associated with emaciation of the body. They differ from Sulphur in coming on also during the day. We have another diarrhoea curable by Petro- leum, and that is a diarrhoea with disordered stomach made worse by the use of cabbage, sauer-kraut and cole-slaw. There is offensive stool with great flatulence, and belching of gas, tasting of cabbage. Petroleum also acts as a nervous remedy. We sometimes find it 470 A CLINICAL MATERIA MEDICA. indicated in typhoid fever, when there is slight delirium. It also pro- duces forgetfulness. The patient loses her way in well-known streets. If this symptom has been produced by exposure to great heat, then you should give Glonoin. Another mental symptom curable by Petroleum is she imagines that she is double, or that somebody is lying beside her. This symp- tom has been utilized in this way: A lady in childbed imagined that she had had two babies, and she was very much concerned as to how she could take care of them both. Petroleum cured her. Petroleum has also been used as an antidote to lead poisoning. LECTURE XLVII. HALOGENS. Halogens. < Highly irritant to the mucous membranes. Spasm of the glottis. Pseudo-membranes. Glands, etc. Bromine. < Phos,, Ant. tart. Carbo an. Aeon., Spong., Hep., Kaol. Kali brom. >Amon. c Halogens. < Fluorine. Iodine. Merc, Phos., Sulph., Calc ostr. Ars., Calc, Arg. n. ] Spong., Hep., Kaolin. I^Ant. tart. >Sulph. >Starch. > Hepar. >Arsen. ^ Chlorine. To-day we begin the study of the chemical elements termed halo- gens; Iodine, Bromine, Fluorine and Chlorine are the elements in this group. As a group the halogens may be remembered by this great characteristic symptom, they all act upon the larynx and bronchial tubes, and in fact upon mucous membranes generally. They are decid- edly irritating to the mucous membranes, producing violent inflamma- tion, rawness and excoriation, as anybody can testify who has once in- haled the fumes of Chlorine, Iodine or Bromine. They all produce spasm of the glottis and this is most marked, has proved most charac- teristic, in Chlorine, although they all have it. They all tend to pro- duce pseudo-membranous formations on the mucous membranes. All excepting Chlorine tend to produce croupous membranes; Chlorine tends more to diphtheritic membrane than pure croupous. All of the halogens act upon the glandular system, producing enlargement, in- duration and even abscess in glands. Thus we find them all useful in 472 A CLINICAL MATERIA MEDICA. scrofulosis, especially Iodine, which leads the list. Cyanogen also be- longs to this group chemically, although it is properly considered as be- longing to organic chemistry. It has many similarities to these drugs, and, like Chlorine, is useful in diphtheritic deposits. Thus we use Hydrocyanic acid and Amygdala Persica (which contains Hydrocyanic acid) for diphtheritic sore-throat, and we may use the Cyanide of Mer- cury for some of the worst forms of diphtheria. The same is true to a less degree of Cyanide of Potassium. These general characteristics of the halogens lead you at times to say, " This patient needs one of the halogens, which shall it be?" To answer that question we must study these four elements separately and by comparison. I will first call your attention to Bromine. Bromine produces a rather peculiar effect on the mind, causing a sort of vertigo, which is worse from running water. Moving rapidly by the patient produces this vertigo. It is associated with a peculiar anxious state of the mind. Now this anxiety belongs to all of the halogens. It hardly originates in the mind, probably coming from some defect in the body itself. It is a common symptom in heart and lung affections, and it is probably thence that the symptom springs. This anxiety is expressed in this way: The patients expect to see objects jump around them or they think that somebody is about them, and they turn around to see if such is the case. This is an effect of Bromine, and those of you who are familiar with Bromide of Potassium will recognize whence it gets its anxiety. The vertigo is relieved by nose-bleed, showing at once that it is congestive in character. Another symptom showing you that there is congestion under Bromine is this: After dinner there is a sen- sation deep in the brain as though a fit of apoplexy wTere impending. The patient feels as if he would lose his senses. The Iodine mental condition is more marked than that of Bromine. It is a decided erethism, during which the patient is very excitable and restless, moving about from place to place, now sitting here, now sitting there; he fears that every little occurrence will end seriously. In his anxiety he shuns every one, even his doctor. He has a great dread of people. At times he becomes quite excited and delirious, with vertigo, red face and anxiety. Next, the lymphatic system. Like all the other members of this group, Bromine attacks the glands and causes enlargement and indu- ration of the glands. Hence it is called for in scrofulosis. It is par- ticularly suited to scrofulous patients, children usually, when the parotid gland or glands are indurated, when there is a tendency to HALOGENS. 473 suppuration, with excoriating discharge and persistent hardness of the gland around the opening, and undue amount of warmth or heat in the gland. I have merely mentioned the parotid gland for purpose of illustration. Bromine also affects the mammary gland, for cancer of which it has been a very useful remedy. You may perhaps remember that I told you the other day that it was similar to Carbo animalis. Like Carbo animalis, it has induration of the glands in the axilla with burning pains. But Bromine also has cutting pains. The breast is hard and on palpation, a dull subdued sort of throbbing may be felt in it. Sometimes the drawing or cutting is so marked that it feels as if a string were pulling from the gland into the axilla. The testicles are acted upon by Bromine. We find them swollen, hard and perfectly smooth. The pain is worse from jarring. The glands are unduly warm and hot. You will find that glandular affec- tions yield to Bromine, especially in persons of light complexion, with fair skin and light blue eyes. I mention this symptom here to make use of it in a few moments as a symptom of comparative value. I do not mean to say that every scrofulous child with blue eyes must have Bromine, but I do mean that this symptom is of use to enable us to distinguish Bromine from the other halogens. The tonsils, too, are affected in Bromine. Thus we find them deep red and swollen and covered with a network of dilated bloodvessels. They are worse when swallowing, and are accompanied usually with swelling of the glands externally. There is a feeling of rawness in the throat wTith this tonsillitis. This, too, as you know, is common enough in scrofulous children. There is a strong temptation to excise the ton- sils, but this is not good practice, for you can often cure this trouble by internal medication. In some cases, this enlargement of the tonsils may be looked upon as a forerunner of tuberculosis. We find Bromine indicated in enlargement of another gland, namely the thyroid gland, and curing w7hat has been termed bronchocele or goitre. We next have to speak of Bromine in its action on mucous mem- branes. Beginning with the nose, we find that it is useful in coryza or in nasal catarrh, when the discharge is profuse, watery and excori- ating. The nostrils, alternately, seemed to be stopped up. There is peculiar headache associated with this coryza, a heavy pressure in the forehead which seems to be pushing the brain down and out at the root of the nose. The nose is very sore inside and also around the alae. This is a decidedly smarting soreness, just such as you would expect 474 A CLINICAL MATERIA MEDICA. the fumes of Bromine to make. Later, ulcers form in the nose, with the escape of crusts or scabs, which are blown out and which are always bloody. Every attempt to wipe the nose is followed by a discharge of crusts and blood. This you know is common enough with scrofulous children. Coming now to the throat and lungs, we find Bromine indicated in spasm of the glottis, sometimes called laryngismus stridulus. This is a very difficult disease to cure. It is often central in its origin. It com- mences by sudden closure of the glottis. The child turns blue in the face, and its body becomes convulsed. One spell ceases only to be fol- lowed by another. In the second stage, general convulsions appear, followed by emaciation. The trouble may be reflex from dentition, or from indigestion, or from enlargement of the thymus gland. If it can be found to be the result of enlargement of the thymus gland, evi- dently then Iodine would be indicated. When it has been caused by retarded dentition, I think that Calcarea phosphorica promises better than anything else. Dr. Dunham records a case that had been given up by an allopathic physician, but, knowing the symptoms of Chlo- rine, which, above all other remedies, will produce this spasm of the glottis, he generated some Chlorine, and allowed the child to inhale the fumes, with almost instantaneous relief and final cure. All the halogens are useful in this condition, but Chlorine is here the best of them all. Their symptoms differ but little so far as the local symp- toms are concerned. We may also think of Sambucus, Antimonium tartaricum, Belladonna, Lachesis, Arsenicum and, in some cases, Phos- phorus. Lachesis is particularly indicated when the patient awakens from sleep with it. Ignatia, whenever a cross word or correcting the child brings on the spasm. Another remedy is Cuprum, especially when the spasms are general and the child clenches its thumbs. Ipecacuanha may be of some use in some cases, but I have no con- fidence in it. Nor have I in Sambucus, because, under Sambucus, I think the trouble is more in the chest, whereas, with Cuprum, the halogens, Cal- carea phos., Lachesis and Belladonna, the trouble is in the larynx itself. This spasm of the glottis often comes in the course of croup, in which disease Bromine may be the remedy when inspiration seems to be ex- HALOGENS. 475 ceedingly difficult; the child is suddenly aroused from sleep as if choking. These symptoms are at least relieved by a drink of water, which seems to quiet the spasmodic condition. In membranous croup Bromine is indicated by the following symptoms in addition to the spasm already referred to : The child has at first a deep, rough voice, which, in the evening, amounts almost to aphonia. The child cries with a hoarse, husky voice. The membrane seems to cottie up from the larynx into the throat. Every inspiration seems to provoke cough, especially every deep inspiration. Breathing is hoarse, rasping and whistling, as though the child were breathing through a sponge or through some loose metallic substance which is vibrating. This is caused by the vibration of membrane as it is deposited more or less uniformly over the interior of the larynx. Later, there is rattling in the larynx. When the child coughs it seems as if the larynx were full of loose mucus. Antimonium tartaricum is very similar to Bromine in croup. It has rattling and wheezing, extending down the trachea as well as in the larynx. Now, I w7ish to say a few words about other remedies in connection with croup, especially concerning Aconite, Hepar, Spongia and Kaolin. Kaolin is a kind of porcelain-clay, a combination of lime and silica, and has proved very useful in membranous croup. The relation which these remedies hold is this : Aconite is useful in the beginning of croup, whether spasmodic, catarrhal or membranous. It is indicated by the child suddenly arous- ing from sleep as if it were smothering. There is great restlessness. The skin is hot. There must be some anxiety present. Breathing is dry. There is no sound of mucus. Pretty soon the child seems better and falls asleep, and then will be aroused again. Aconite is especially indicated in vhese cases if these symptoms have followed exposure to dry, cold winds. Do not stop your remedy too soon. If you do, while the child will be better in the morning, the symptoms will return with renewed violence the next night, and, before you know it, the mucous membrane of the larynx and trachea will take on fibrinous exudation and you lose your patient. You will need to change to Spongia when you have these symptoms present : Breathing during inspiration is hard and harsh, as though the child was breathing through a sponge. The cough has a decidedly hard, barking, ringing sound. The sputum is scanty as yet. Spongia follows Aconite, especially after exposure to dry, cold winds, and in light-corn- 476 A CLINICAL MATERIA MEDICA. plexioned children with blue eyes. The symptoms are usually worse before midnight. Suppose this fails you, then you may have recourse to Hepar sulphuris calcarea. Hepar usually has its symptoms worse after midnight and towards morning. The cough has the same harsh, croupy sound, but there is a great deal of moisture with it. This is the indication for Hepar. It, too, is worse from exposure to dry, cold wunds. Sometimes all these drugs fail, and we have to resort to the halogens, especially to Bromine and Iodine. I have already given you the symptoms of Bromine; let me tell you how to distinguish it from Iodine. Iodine is particularly indicated after the failure of Hepar, when the membrane has formed; inspiration is exceedingly difficult, both from spasm of the throat and occlusion of the lumen of the larynx by the membranous formation. Inspiration is wave-like, or in jerks. The cough is moist but harsh, just as you found under Hepar. The voice is almost extinct from the hoarseness. The child grasps its throat to relieve the pressure, throws its head far back so as to straighten the route from the mouth to the lungs and favor the passage of air. It is particularly worse in the morning. Iodine is especially adapted to dark-complexioned children with dark hair and eyes. This in itself is a great distinction between Iodine and Bromine. That is why I spoke of the use of Bromine in light-complexioned chil- dren, because this fact has been proven to be a good distinction between these two drugs, and hence, as a comparative symptom, is one of great value to you. Iodine is particularly adapted to cases that come from damp weather. Long-continued damp cold weather will produce just such a cough as Iodine will cure. Do not change your remedy in these cases too often. Do not change your remedy on account of alarming symptoms that spring up, unless you are certain that they indicate a change. Kaolin has been used successfully for membranous croup even when the membrane dips down deep into the trachea. There is extreme soreness of the chest. The patient does not want anything to touch him. He will not permit you to use steam or hot cloths, because the chest is so sore. Returning to the study of Bromine, we find it useful in affections of the lungs. It is indicated in asthma, when the patient feels as if he could not get air enough into his lungs, consequently he breathes very deeply. The explanation of this lies not only in the lungs, but also in the constriction of the glottis. Although the patient expands his chest HALOGENS. 477 well, air does not go in on account of the narrowness of the opening in the larynx. It is especially indicated in asthma coming on, at or near the seashore. We also find Bromine useful in pneumonia, particularly when it affects the lower lobe of the right lung, hence lobar pneumonia. We often find nose-bleed as a concomitant symptom when Bromine is indi- cated in these cases. The patient also has the symptom just mentioned under asthma, '' seems as if he could not get enough air into the chest;" while there seems to be plenty of mucus, the patient does not appear to be able to expectorate it. We also find Bromine indicated in tuberculosis of the lungs, par- ticularly when the tubercular deposit is more manifest in the right lung. The patient suffers frequently from congestion of the head and chest, which is relieved by nose-bleed. Notice how often that symptom occurs under Bromine. There is also pain in the mam- mary region going up into the axilla. The eyes seem to be affected along with the chest symptoms giving rise to a chronic conjunctivitis. Bromine produces a very characteristic picture of uncomplicated hypertrophy of the heart, by which I mean, muscular enlargement without valvular lesion. The patient finds it difficult to exert himself on account of the oppression about the heart. He kas palpitation when he begins to move and when he gets up from a sitting to a standing posture. The pulse is full, hard and rather slow, which is just the character that belongs to an over-active enlarged heart. It has cured many cases of this hypertrophy of the heart. I think it was Dr. Thayer, of Boston, who cured many cases of this trouble with Bromine. It may also be used in cardiac asthma, especially when the asthmatic paroxysms are better at sea than on land.* You here find Bromine similar to Aconite, but it lacks the anxiety of that remedy. Both remedies are suited to uncomplicated cardiac hypertrophy, but Aconite has fear and anxiety. The patient fears that he w7ill drop dead in the street. It is also similar to Arnica and Rhus tox., both of which remedies have uncomplicated hypertrophy of the heart from over-exertion. So much for Bromine; now for Iodine; and first let me speak of the symptoms arising from its abuse. Iodine is an absorbent; it has * Professor Farrington refers above to the asthma of Bromine as coming on at or near the seashore, and here he speaks of cardiac asthma better on sea than on land. Both may be right, for being at sea differs from being at the seashore, where you may have land breezes.—S. L. 478 A CLINICAL MATERIA MEDICA. the property of causing absorption, particularly of glandular struc- tures. Its absorbent properties extend to other tissues, involving, finally, even nervous structures. We find, for instance, in persons who are poisoned with Iodine, great emaciation. With the female, the mammary glands become atrophied and the ovaries, too, no doubt. With the male, the testicles suffer with inevitable progressive loss of sexual power. The skin becomes dark yellow and tawny, dry from deficient action, the sclerotica become yellow, yellow spots appear on the face and also on the body. There is excessive appetite; he is anxious and faint if he does not get his food. He is relieved while eating and yet he emaciates despite the amount of food he eats. Sooner or later the nervous system becomes involved and he is afflicted with tremor. He becomes nervous and excitable; every little annoyance which would be unnoticed in his normal condition causes trembling. He has a longing for the open air, as if the cold fresh air gave him more breath. This gives a fair idea of the condition to which the patient is reduced by the over use of Iodine. One of the best antidotes for this state is Hepar. Some cases require Sulphur. The individual symptoms decide. Now compare Iodine with Bromine in chest affections. Iodine is indicated in pneumonia, more so, perhaps, than Bromine. It is espe- cially useful when the disease localizes itself, that is when the plastic exudation* commences. There is a decided cough with great dyspnoea, difficulty in breathing, as though the chest would not expand (and here the trouble is situated in the chest itself), and blood-streaked sputum. You will find some portions of the lungs beginning to solidify. You may also give it later in the disease, after the stage of hepatization, in the stage of resolution, when instead of absorption and expectoration of the exudate, slow suppuration appears with hectic fever and emaciation; the patient feels better in the cool open air than he does in the warm room. Phthisis pulmonalis sometimes calls for Iodine. You here find it indicated in young persons who grow too rapidly, who are subject to frequent congestion of the chest, who are rather emaciated, and who suffer from dry cough, which seems to be excited by tickling all over the chest. The patient cannot bear the warm room. Expectoration is tough and blood-streaked. There is a well-marked feeling of weak- * Under Mercurius and Iodine, exudates are plastic; Bryonia, serous and plastic; Hepar, purulent. HALOGENS. 479 ness in the chest, particularly on going up stairs. The patient has a very good appetite, and is relieved by eating. The nearest remedy to Iodine here is Phosphorus, which is also well adapted to phthisis in the rapidly-growing young. Iodine is also indicated in enlargement of the heart, whether or not accompanied by disease of the valvular structures. There is palpitation of the heart, particularly after any manual labor. It is suited especially to dark-complexioned persons, with dark hair, etc. The heart feels as if it were being squeezed by a firm hand. At other times there is ex- cessive weakness in the chest, with " goneness " or exhausted feeling. The patient can scarcely talk or breathe, so weak does he feel. This shows that Iodine acts on the connective tissue. In valvular affections there is a purring feeling over the heart, just such a sensation as you get when stroking a cat. Spigelia has that same purring, vibrating feeling over the region of the heart. Now let me give you the difference between Iodine and Bromine in scrofulous affections. Iodine causes induration of the glands more marked than does Bromine. They are hard, large and usually painless. There is a characteristic of Iodine which is universal, and that charac- teristic is torpidity and sluggishness. The very indolence of the dis- ease is suggestive of Iodine. It also produces atrophy of the glands. The mammae waste away and the testicles dwindle. We find it indi- cated in scrofulosis of children, when they emaciate rapidly, despite a ravenous appetite. They are hungry all the time. They cry for their dinner, they feel better while eating, and yet they do not gain any flesh. They are always better in the open air and worse from any con- finement in the warm room. The mesenteric glands are enlarged, and you have what is known as tabes mesenterica. This indicates Iodine, particularly when you have these other symptoms present together with excessive mental irritability. We find Iodine causing a rather singular diarrhoea. In such cases the spleen is enlarged, quite hard, and very sensitive to the touch. The liver, too, must.be affected, because the stools are whitish; sometimes they are whey like. This last symptom you will often find connected with obscure disease of the pancreas. Iodine has such an affinity for glandu- lar structures, that it, no doubt, attacks the pancreas as well as other glands. We also find Iodine affecting the ovaries. It is indicated in ovarian dropsy. In such cases as this, the single fact that Iodine has helped 480 A CLINICAL MATERIA MEDICA. in ovarian dropsy, must not lead you to give Iodine in every case of that trouble. Other remedies have proved themselves useful. Apis, Colocynth, and other drugs, have cured cases, and they have sometimes failed. If the whole picture of the patient calls for Iodine, it is your duty to give that drug, but not unless such is the case. It must be given for weeks or months before it will bring about absorption of the tumor. We also find Iodine indicated in cancer of the uterus, particularly with profuse hemorrhages. The leucorrhcea is characteristic, being yellowish and very corrosive. This, in conjunction with the other Iodine symptoms, sallow, tawny skin, ravenous appetite, etc., makes Iodine the remedy which will relieve many cases and cure some. In this connection we have other remedies to remember, and notably among these, Hydrastis, which has cured epithelioma, and may be a remedy for uterine cancer. I have, however, had no personal success with it. It has been used both externally and internally, when indi- cated by symptoms which have already been given you in another lecture; especially has it marked goneness at the epigastrium, and pal- pitation after every motion. There is a substance, or remedy, known as Lapis albus. It is one of Grauvogl's remedies. He, at one time, went to a certain spring, the waters of which, it was claimed, would cure tuberculosis, scrofulosis, and even cancer. On examining the spring, Grauvogl noticed that the water had gradually worn a crevice in the rocks. He took away a piece of this rock over which the water was falling, and made tritura- tions of it. With this he cured several cases of goitre, and also several cases of scirrhus. This rock has been analyzed, but the analyses differ so that I hardly know which one to recommend. Iodine is sometimes indicated in rheumatic joint affections, with effu- sion and emaciation. Hydrarthrosis yields, according to Jahr, Jousset and others, to Iodine. In acute cases, compare Apis; in the chronic, Sulphur. Both Iodine and Bromine are of some use in ulcers. Iodine, for in- stance, is useful in ulcers rather of a scrofulous form, with spongy edges, and discharges of a bloody, ichorous, or even purulent character. Now, Bromine is somewhat similar. It is useful in ulcers which have a carrion-like odor, with threatening gangrene. The surrounding skin has a greenish-yellow hue. That is the form of ulcer to which Bromine is especially adapted. Now, a few words about Chlorine. I do not know much about it as HALOGENS. 481 a medicine. It may be given in a crude form by allowing the gas to be absorbed by ice-cold water, and thus it maybe prepared for the cases to be enumerated. Chlorine, and in fact all its combinations, seem to have a special affinity for mucous membranes. Hence we find it in- dicated in catarrhs. Chlori7ie produces a watery discharge from the nose, with a thin, excoriating coryza, making the nose, both inside and about the alae, sore. On examining the mouth, you find it, too, affected with a low grade of inflammation. Chlorine here produces small, putrid- smelling ulcers. These are aphthous in character. You find the mouth filled with yellowish-white aphthae. Chlorine is indicated in scorbutic states of the blood, and so are all the chlorides. We find under Natrum mur. and Kali chloricum the same kind of stomacace, with excessive fcetor of the breath. We find Chlorine also acting on the nervous system, probably through the blood. It is indicated in typhoid conditions; the patient has a fear of becoming crazy, or that he will lose his senses. He is very forgetful; he cannot remember names, etc. There is a constant fear of some impending disease. There is also, under Chlorine, a peculiar painful sensation in the vertex, this sensation passing down the left side of the body.. This is a precursor of typhoid fever. It is worse after eating. In such cases Chlorine will often modify the fever. Chlorine is also indicated in impotence. When this impotence has been produced by inhalations of the fumes of Chlorine, Lycopodium is the proper antidote. Chlorine is a very good antidote to Sulphuretted hydrogen. 31 482 A CLINICAL MATERIA MEDICA. Spongia. < Spongia. Aeon., Bell., Hep., Iod., Brom. Anacardium. Caust., Selen., Phos. Badiaga. Spongia is not a chemical substance. It is derived from the animal kingdom, but, because its symptoms are closely allied to those of the halogens, it is convenient to study the drug here. Spongia contains Iodine, also some Bromine and some calcareous matter, and probably other ingreaients of minor importance. Spongia has not the same symptoms as Iodine. In the first place, it is adapted to light-com- plexioned persons, and it has not the same property of producing plastic or fibrous exudates that Iodine has. It acts, however, on structures very similar to those influenced by the halogens, especially the glandular system and mucous surfaces. We find it of service in tuberculosis, and we shall find it invaluable in the treatment of heart disease. First, let us study its action on the glands. It is indicated just as are the halogens in indurations and enlargement of the glands. Thus we find it indicated in goitre. The swelling is hard and large, one or both sides are swollen, sometimes even with the chin, and par- ticularly is this associated with suffocating spells at night. This suf- focation does not come alone from the size of the goitre, because some very small goitres give rise to this symptom in a very great degree. I would also call your attention to the fact that goitres will vary in size at different times. They will be larger at one time than another. It is said that they increase and decrease with the moon. It has, therefore, been suggested that you give Spongia, or whatever drug you select, with the waning moon. In this way you hurry its decline. Spongia acts just as powerfully as the halogens on the testicles, producing hardness and swelling of these glands. It is particu- larly useful in cases of maltreated orchitis or inflammation of the testicle after checked gonorrhoea. There is a peculiar sort of squeez- ing pain in the testicle and cord, worse on any motion of the body or clothing. In cases of orchitis, our first remedy is not Spongia. Pulsatilla stands at the head of the list, and next to it we may rank Hamamelis, SPONGIA. 483 or witch-hazel. The latter drug should be used both locally and in- ternally. It relieves the intense soreness and enables the patient to attend to his duties. Still another remedy is Mercurius solubilis, par- ticularly when what little gonorrhoeal discharge is present is yellowish- green. Still another remedy in the very beginning is Gelsemium. When, however, you have this peculiar screwing-like, squeezing pain in the cord and testicle, with hardness there, Spongia comes in as one of our best drugs. We find Spongia indicated in acute laryngitis. This is an alarming disease. We find Spongia indicated after Aconite, when there are harsh, barking cough and suffocative spells during sleep, arousing the patient. The larynx is extremely sensitive to the touch. Do not give Lachesis in these cases, for the sensitiveness is not due to hyperaesthesia of the cutaneous nerves, but it is the result of the inflamed condition of the laryngeal cartilages. If the patient turns his head, the movement will bring on a suffocative spell. Now there is another remedy that I would have you remember in this connection, and that is Sambucus. This is useful when these spasms of the larynx occur frequently during the course of acute laryngitis. You will find the same symptoms that suggest Spongia in laryngitis also indicate it in laryngeal phthisis. I will not speak of the application of Spongia to croup, because I gave that to you in the early part of this lecture when speaking of Bromine and Iodine. We come next to the lungs. We find Spongia indicated in con- sumption of the lungs, in true tuberculosis. It is especially called for in the beginning of the stage of solidification of the lung tissue. You find the apices of one or both lungs dull on percussion. The cough is of a hard, ringing, metallic character. It is excited by deep breathing or by talking, by dry, cold winds, seldom by damp weather or by any little excitement. It is relieved for awhile by eating or drinking. Anacardium also has this same symptom, eating relieves the cough. There is a great deal of congestion of the chest, especially when the patient is moving about, walking in the street for instance. This is accompanied by sudden weakness as if the patient would fall. In such cases Spongia has cured when given early. It is well followed by Hepar when the same kind of cough con- tinues, but with rather more rattling of mucus, more production of 484 A CLINICAL MATERIA MEDICA. phlegm, whether blood-streaked or not. The symptoms are worse towards morning, while with Spongia they are worse before midnight. You find, too, that the Spongia patient is subject to frequent flashes of heat in these phthisical cases, and these return whenever he thinks about them. He also experiences a chill which usually commences across the back. He shakes even when near a warm stove. The heat which follows is all over the body except the thighs, which remain numb and chilly. Spongia is useful in organic affections of the heart. The patient cannot lie flat on the back with the head low without bringing on a spell of suffocation. He is frequently aroused from sleep as if smother- ing. He sits up in bed with an anxious look and flushed face, and rapid, hard breathing. You will find a loud blowing sound over one or the other valve. Spongia is particularly indicated after Aconite. Here there is the same arousing from sleep with great distress, the face is red and there is probably great congestion of the chest. Aconite suits only the hy- peraemia that precedes endocarditis. Spongia comes in when exuda- tion has commenced and the mischief has been already done. While it does not remove the deposit, it prevents the disease from advancing. In treating heart cases do not begin too soon with Lachesis, Hydro- cyanic acid or Arsenicum. Begin rather with Aconite, Spongia, Spigelia, Bryonia or Phosphorus. Arsenic and such remedies come in later. If you give them too soon you weaken the patient. Unless you have a complete picture for the remedy, do not give in the first stages one usually indicated in the last stages of a disease. LECTURE XLVIII. THE ACIDS. Fluoric acid. Phosphoric acid. Muriatic " Hydrocyanic " Nitric Picric Sulphuric " Lactic Oxalic " Malic Citric Silicic Arsenious acid. There are many of the acids, many more in fact than have been placed on the board. There are not many of them, however, with which we are thoroughly7 acquainted, and there are but few facts that need be stated with reference to others. The very idea of acid you will at once understand, implies that they are more or less electro-negative. They all combine very readily with the electro-positive substances, as potassium and sodium. You must rid yourself of the impression that the term '' acid '' necessarily implies that these substances are sour, for all acids are not sour nor do all acids redden litmus paper. It was formerly supposed that all acids contained oxygen, and that oxygen was one of their necessary ingredients. This has been disproved, for certain acids—as hydrofluoric and muriatic acids—contain no oxygen. These acids are derived from the mineral and vegetable kingdoms. Of those derived from the former, we use in medicine Fluoric and Muriatic acids, which are obtained from the halogens; Nitric acid, a combination of nitrogen and oxygen; Sulphuric acid, Phosphoric acid, Silicea or Silicic acid, which exists as sand in nature and is by no means sour. So, too, the substance which we term Arsenicum is an acid— Arsenious acid. Then we have derived from organic chemistry Hydrocyanic acid, sometimes called Prussic acid. That, we shall find, exists in a great variety of plants. Then here is Oxalic acid. That you are some- 486 A CLINICAL MATERIA MEDICA. what familiar with. Many of you who have tasted the " sorrel grass" know how sour the leaves are. It is Oxalic acid which gives them their acidity. It exists also in the rhubarb. Rhubarb, either the medicinal or the edible variety, may or may not be poisonous. When raised on new ground it is very apt to contain an undue amount of Oxalic acid, and thus may make some persons very sick. Malic and Citric acid are derived from the vegetable kingdom. Malic acid is found more particularly in apples and pears and also in raspberries. Citric acid is found chiefly in oranges and lemons. Acetic acid is an organic acid, and is the principal ingredient of vinegar. Lactic acid is aerived from sour milk. In the first place we may say a few words about the acids in general and tell what characterizes them as a class. It has been determined by careful experimentation with the acids as a class that they decrease the acid secretions of the body and increase the alkaline. If, for in- stance, a quantity of acid, such as Citric acid, is taken into the stomach, it will diminish the secretion of the gastric juice. On the other hand, it will increase the secretion of the saliva. The practical value of this hint is hygienic rather than therapeutic, and yet in that degree it is of great use. For instance, we know how intolerable, at times, thirst is in fevers. Now this thirst may be due, at least in part, to lack of secretion from the salivary glands. The mouth is parched and dry; the tongue cleaves to the roof of the mouth. In such cases as this, acidulated drinks, by acting reflexly, increase the flow of saliva, and will give your patient great relief. For instance, you may give lemonade, providing, of course, it is not antagonistic to your indicated remedy, for there are some medicines which Citric acid will anti- dote and some which will disagree with it. Again, if you are giving Belladonna, you would not think of using vinegar, as vinegar retards the action of that drug. But when giving Belladonna you may use lemonade, as that aids the action of the remedy. Antimonium crudum will not tolerate acids, but you may use tamarind water. Now if you find the mouth or throat sore in fever, the " edge " must be taken off the acid by the admixture of some mucilaginous substance to the drink. You might use gum Arabic, but that interferes with digestion somewhat. Irish moss, Iceland moss and slippery-elm are too medic- inal. They all act powerfully on the lungs, and you might induce medicinal symptoms if you employ them. Flaxseed has some medic- inal effect, but not sufficient to make its use inappropriate. Another substance which may be used is gelatin, that is, if you know that it is THE ACIDS. 487 made properly. Some of it is made from the refuse of the tanner; some from fish-bones, and that is quite palatable; but best of all is that made from calves' feet. This last may be used in water to relieve this sharp- ness. We find that acids may be useful in dyspepsia, not as remedies (their therapeutic uses we shall see presently), for we are now speaking of their hygienic applications. You may give them, for instance, in sour stomach. You then administer the acid before eating. Allow the patient to drink lemonade before'meals and you will often find that the usual heartburn and sour risings after eating are thus diminished. Pep- sin, which is often used as an adjuvant in the treatment of dyspepsia, is perfectly allowable, as it does not interfere with the action of any medi- cine and is not itself a medicine, and is often aided in its action by some kind of acid, particularly in the digestion of nitrogenous articles of food. Vinegar has been used as an antidote for intoxication. There is a property of the Lactic acid which is well worth noticing. This is a very corrosive acid. It will eat into every tissue of the body. In fact, it will dissolve the enamel of the teeth, so that great care must be used in its administration. When prescribed in material doses, it is usually administered through a tube, which prevents it from touching the teeth. Dr. Hering was in the habit of recommending that the teeth be washed occasionally with cream that had become sour by keep- ing twenty-four hours. Muriatic and Lactic acids favor digestion. Some persons are greatly relieved by drinking sour milk. Sulphuric acid must be avoided in any form whatever, because it tends to make the food insoluble by combining with its albuminous constituents. Sulphuric acid is not used in dietetics, except by children in the " sour-balls," which are acidulated almost exclusively with this acid. Hydrocyanic acid certainly aids digestion. There are some persons who have been cured of dyspepsia by eating peach-kernels, which con- tain this acid. There is a distinction between the mineral acids on one side and the organic acids on the other. The mineral acids, as a class, all produce an irritability of fibre together with weakness and prostration. I am now speaking of their medicinal effects. You will find them to pro- duce an irritable weakness—the pulse is weak and irritable—whereas the vegetable acids produce weakness without irritability. The acids, 488 A CLINICAL MATERIA MEDICA. too, as a class, check haemorrhages. This is a quality that belongs to nearly all of them. We all know that Acetic acid is useful in check- ing haemorrhage. When I have a patient who is subject to haemor- rhage, I am in the habit of instructing the nurse, in case haemorrhage sets in before I can be called, to dip a cloth in vinegar and place it over the pubes. In many cases, this will be successful. We all know, too, that Citric acid will produce and cure haemorrhage. A child, after eating too freely of lemons, had haemorrhages from every orifice of the body, even from the conjunctiva. We shall see that Phosphoric, Sul- phuric and Arsenious acids all produce and all check haemorrhages. It is said that they all do this by reason of their astringency. But how can this be so when they act favorably even in the two-hundredth potency ? Another quality of the acids is their tendency to produce pseudo- membranes. Thus we find some of them indicated in diphtheria; Muriatic, Phosphoric, Sulphuric and Nitric acids, for instance. Here, again, caution is necessary. As these acids, particularly the vege- table acids, may cause croupous deposits, do not permit a child con- valescing from croup to partake of acid fruits. When the child is susceptible, any one of these acids may tend to produce this disease again. We find that all the acids cause a peculiar debility. This is not a simple functional weakness, such as might result from a rather exhaust- ing diarrhoea, such as you find under Cinchona, or such a functional weakness of the nerves as will be curable by Zinc, but it is a debility which arises from defective nutrition, particularly from blood disease. Thus we find them called for in very low types of disease, disease in which blood poisoning is a prominent feature, in typhoid states and in scarlatina, particularly when of a low type, in conditions of exhaustion from abuse of various organs of the body. Thus drunkards, who have long been indulging in liquors to excess, maybe relieved by Sulphuric, Phosphoric and Arsenious acids. We find them indicated, too, in diabetes mellitus. The principal acids for this condition are Phosphoric and Lactic acids. We find, too, that many of the acids are useful in scurvy, particularly when it has arisen from a diet of salty food with deprivation of vege- tables. So much for our general review of the acids. We will now begin to speak of the acids in order, and first of all, of Fluoric acid. FLUORIC ACID. 489 Fluoric acid. Fluoric Acid. Silicea, Calcarea ostr., Calcarea fluor. Kali carb. Arsenicum, Phosphoric acid. Mercurius. Rhus tox. This is a highly excoriating acid, eatin.g, as you know, even into glass. It is to be particularly remembered from its action on the bones and on the skin. It acts especially upon the lower tissues of the body. We find it indicated in caries of the bones, particularly when the long bones, as the femur, humerus and radius are affected. The discharges from the affected parts are thin and excoriating. The symptoms are frequently relieved by cold applications. Fluoric acid is frequently use- ful for caries of the temporal bones, and especially of the mastoid pro- cess, and that, too, whether it be the result of syphilis, or of scrofulous catarrh of the middle ear. We also find it indicated in dental fistulae. The discharge is bloody, and has a saltish, disagreeable taste, rendering the mouth foul, and gradually undermining the whole constitution. Fluoric acid will here relieve. There is another remedy which has not been thoroughly proven, but which seems to act better here than the Fluoric acid, and that is the Fluoride of Calcium or Calcarea fluorica. Calcarea fluorica is especially useful for osseous tumors and for enlargement of bones with or without caries. This summer a lady came to my office with what the dentist had pronounced to be necrosis of the lower jaw on the left side. The teeth had been removed by him, but the patient, instead of getting better, grew worse, and there was a continual discharge from the cavity. The molar just back of the one taken out had been filled with gold, and that I found on ex- amination to be rough at its root; and when she would press her jaws together tightly, there would ooze, apparently from its fangs, a fluid which was offensive, dark and bloody, and mixed with fine pieces of decayed bone. The gum around the bone was purple and offensive in itself. The dentist had said that a surgical operation was necessary. The first remedy given was Silicea, which seemed to have some effect. This was followed by Fluoric acid. These two remedies are comple- mentary, and you will frequently find in bone disease that you will have to give one after the other. Fluoric acid is especially indicated w7hen Silicea has been abused. It is also indicated when Silicea appa- 49Q A CLINICAL MATERIA MEDICA. rently does some good but fails to complete the cure. Now, in the case I have just related, Fluoric acid also helped for awhile, but im- provement again came to a stand-still, and now I noticed a swelling of the bone on the outer surface. This led me to think that Calcarea fluorica would act better, and I gave it in the sixth trituration. That she has been taking since the first of August. A ,week ago* the dis- charge had entirely ceased. The tooth, which had been filled with gold, was no longer painful. Pink granulations were springing up all over the gums. The probe can no longer detect bone which is diseased. You will remember, as a distinction between Fluoric acid and Silicea in bone affections and ulcers, that Fluoric acid has relief from cold, whereas Silicea cannot bear anything cold. The slightest draught is intolerable. We next have to speak of the action of Fluoric acid on the skin. Jt seems to produce a decided roughness and harshness of the skin, de- veloping cutaneous eruptions of various kinds. There is itching. I do not know of any remedy that causes such general and persistent itching as does Fluoric acid. There is itching in small spots here and there over the body. This is worse from warmth and better from a cool place. You will find, under Fluoric acid, that old cicatrices will become redder than natural and itch. By and by, little vesicles will form on or near the cicatrix, thus showing you the affinity of Fluoric acid for this kind of tissue. Then little red blotches appear on the body, and you have well-marked tendency to desquamation. No remedy has this more marked than Fluoric acid. You will find that Fluoric acid also attacks the nails, causing them to grow rapidly. Thuja has the effect of making the nails grow soft. We may use Fluoric acid in felons, particularly in bone felons. Here, as in case of other diseases of the bones, the discharge is offensive. Here, also, we may make the same point of distinction between it and other remedies, relief from cold applications. Fluoric acid also acts upon the muscles. Here its effects are rather novel. It causes an increase in muscular endurance. Under its influ- ence a person is able to withstand more muscular exercise than that to which he is accustomed. More than this, he seems to be better able to withstand the heat of summer and the cold of winter. Thus the drug has a general invigorating or tonic effect. *The lecturer was speaking on October 17th. FLUORIC ACID. 491 This same effect we find under other drugs. We know how Rhus tox. will enable persons to withstand muscular fatigue. The same is also true of Arsenicum. But the remedy that has this property, more than any other I know of, is Coca. This interesting plant is used by the people of South America, particularly by those who climb the Andes. It prevents all the symptoms arising from the fatigue of the journey and from the disproportion between the external and the in- ternal atmospheric pressures. We may make use of this in persons w7ho are weak, particularly for old people who get out of breath easily when and particularly if they cannot stand a rarefied atmosphere. In that condition Coca relieves. Under the influence of Fluoric acid, a short sleep seems to refresh. This effect may also be produced by low potencies of Mephitis putorius. We find that Fluoric acid has produced, and therefore ought to cure, varicose veins. Little blue collections of veins in small spots were caused in twro or three provers by Fluoric acid. It may also be of use in naevus. Other remedies here are Hamamelis, especially in acute cases. It is often used externally and internally in the treatment of enlarged veins. Muriatic acid. Muriatic Acid. f Debility, typhoid fever. J Diphtheria. Scarlatina. Muscular weakness from Opium. Muriatic acid. < Rhus tox., Bry. Apis, Rhus tox. Opium. Nitr. ac Phos., Phos. ac. Arsenicum. f Camphor. > 1 Bryonia. Alkalies. Now that we have obtained an idea of the acids in general, we will find Muriatic acid a very easy drug to study. The continued use of Muriatic acid must give us pathological effects. Now this acid, when abused, produces pathogenetic effects, which present two series of symp- toms for study. We find its mental and nervous disturbances under two stages or classes. Under the first effects of the drug there is con- siderable excitement. The patient is irritable and peevish, and the 492 A CLINICAL MATERIA MEDICA. senses are all too acute. Thus light hurts his eyes, distant noises cause buzzing or roaring in the ears, or aggravating headache. Both smell and taste are abnormally acute. The patient is restless and changes his position frequently. His mind is actively engaged in visions in reference to the past and present and even to the future. The cheeks are quite bright red, the tongue and mouth are apt to be dry, and the heart-beat is quick and irritable. The heart-stroke, though quick and irritable, lacks energy and force. If he is at all delirious, it is only slightly so. He is sleepy but unable to sleep, or he tosses about, dreamy and restless, all through the night. Now these are the tran- sient symptoms of excitement or over-exertion which may occur under the influence of Muriatic acid. You are able to trace under these symp- toms, from beginning to end, a certain amount of weakness. There is an appearance of over-strength, but it is in a weakened constitution. You know that it is not a true " hyperaction," but only an irritability, that comes under the head of irritable weakness. The next stage, or that of exhaustion, has several grades, of course. Beginning with the mental symptoms, we find that the patient is apt to be sad, and is absorbed in self, so as to be taciturn, rather introspec- tive, sad and brooding. If you question him you will learn that he is anxious' about something real or imaginary. Headache may now appear, the feeling being as if the brain were being torn or bruised, or there is heaviness as if the occiput were made of lead. The patient becomes unconscious, with muttering delirium, sighs and groans during sleep, the tongue grows more dry and seems to have actually shrunken and become narrow and pointed; so dry is it that when he attempts to talk, it rattles like a piece of wash leather in his mouth. Still later, the tongue becomes paralyzed, so that he can scarcely move it at all. The heart-beats are regular and feeble. The pulse intermits characteristically at every third beat. He now becomes so weak that the muscles refuse their office. He has diarrhoea, which is watery and is accompanied by prolapsus of the rectum. Stool is involuntary when straining to urinate. He slides down in bed. He actually has not sufficient strength to keep his head upon the pillow. There is now threatening paralysis of the brain. This is indicated by vacant, staring eyes, dropping of the lower jaw, coldness of the extremities, and this, if not checked, is followed by death. Now these are the symptoms that call for Muriatic acid, particularly in typhoid fever. The concordant remedies of Muriatic acid here are Rhus, Bryonia, Apis, Phosphoric acid, Nitric acid and Arsenicum. MURIATIC acid. 493 Bryonia resembles it in the early stages of typhoid fever. Both have that nausea when sitting up in bed, both have dry tongue and soreness through the body, but there are quite a number of other symptoms which will enable you to distinguish, and which have been mentioned in the lecture on Bryonia. Rhus tox., like Muriatic acid, has this restlessness in the beginning. The patient is continually moving and tossing about the bed. He can- not sleep at night. There is slight delirium, with muttering. All these symptoms are under both Rhus and Muriatic acid. Rhus has not so much debility as the latter, hence it is followed rather than pre- ceded by the Muriatic acid. Phosphoric acid resembles Muriatic acid, but resembles it in this re- spect: Phosphoric acid has apathy and indifference; a complete " don't care condition;" indifferent to what may happen to himself, or to others. That is not the condition calling for Muriatic acid, for taci- turnity is not indifference. Then again, Phosphoric acid does not cause the same prostration that we find under Muriatic acid. The character- istic stupor of Phosphoric acid is this: The patient is easily aroused from stupor, and is perfectly rational when aroused, no matter how soon he may drop off again to sleep. Apis resembles Muriatic acid. Both remedies have this dry and shrunken tongue, both have sliding down to the foot of the bed, im- pending paralysis of the brain, etc. The Apis tongue is very charac- teristic, and differs from that of Muriatic acid. It is covered with little blisters, especially along the border. The patient cannot put the tongue out; it seems to catch on the teeth, or, if he does get it out, it trembles. Arsenicum you can readily distinguish by the symptoms, which I will give you next week when I lecture on that drug. You should also remember in this connection Baptisia, which has in common with Muriatic acid, this great weakness. Baptisia, how- ever, has a besotted look to the face; the teeth are covered with black sordes, and the tongue is red on the edges and yellowish-brown down the centre. Now, a word of caution. Do not mistake the symptoms of Muri- atic acid for those of Belladonna. The novice is apt to do it. For instance, you notice the flushed face, the over-excitement of the senses, desire to sleep but cannot; these are all symptoms of Belladonna. But try to find the meaning of the Belladonna symptoms and then of those of Muriatic acid, and you will find that they are by no means 494 A CLINICAL MATERIA MEDICA. the same. The Belladonna symptoms apply to hyperaemia, and to the beginning of the disease, and not to overwhelming of the system by disease, as in Muriatic acid. Next I wish to refer to Muriatic acid in scarlatina. The body is intensely red, looks like a boiled lobster. There is rush of blood to the head, with bright red face and with great drowsiness. Now the rash comes out very sparingly, and is scattered irregularly over the surface of the body, and interspersed with petechiae, with bluish or purplish spots. The child is very restless, throws off the clothes, and will not be covered. As the symptoms progress, the skin becomes purplish and the feet decidedly blue. Then you may have also some of the diphtheritic symptoms already referred to. Catarrhal or even diphtheritic symptoms may complicate the case. There is thin, ex- coriating discharge from the nose, making the upper lip sore. So irritating are "the discharges from the mouth that the mucous membrane becomes intensely red, and even denuded of its epithelium. By and by, yellowish-gray deposit forms in the mouth, and particularly in the fauces, and on the tonsils, uvula, and posterior wall of the pharynx. One of the provers had symptoms that made it difficult to decide between those of diphtheria and those produced by Muriatic acid. The breath becomes very fcetid, and the uvula, oedematous. Sometimes the latter hangs down as thick as your thumb, and lies on the tongue, and causes the child to gag and choke. These are the diphtheritic and catarrhal symptoms, and they may occur with or without scarlatina. Belladonna is apparently, not truly, a concordant remedy here. These symptoms may cause you to give Belladonna, and incorrectly too. The drowsiness and disturbed sleep, etc., of this remedy are caused by congestion of the brain, which is not the case under Muriatic acid. More closely allied are Apis and Sulphur, which both produce red- ness of the skin to a marked degree. Kali permanganicum resembles Muriatic acid in the throat symptoms, especially in the oedematous uvula. Other remedies having this symp- tom are Apis, Natrum arsenicosum, Mercurius cyanatus, Arsenicum and Hydrocyanic acid. This last remedy resembles Muriatic acid in its throat symptoms, and in the blueness of the surface, and in the presence of petechiae in the rash. Sulphuric acid resembles Muriatic acid in scarlatina in that both remedies have these bluish spots, great weakness and diphtheritic membrane. Sulphuric acid has not relief from uncovering. Then MURIATIC ACID. 495 again, there are appearances on the skin like suggillations. Spots appear that look as though the parts had been bruised. I have also found Muriatic acid useful in the last stages of dropsy from cirrhosed liver. Of course it may be used in any other serious disease of the liver in which the symptoms indicate it. The dropsy progresses as it does ordinarily in cirrhosed liver. The patient finally develops a typhoid condition, and becomes drowsy\ Now these are the symptoms for which I have selected Muriatic acid. It does not cure; it will only relieve. The patient is drowsy, and becomes very much emaciated. The mouth is dry or it is aphthous. The stools are often watery and involuntary. The stomach is so weak and irritable that no food can be retained. Nitro-muriatic acid is also to be remembered in these cases of weak digestion. Its symptoms you will find recorded in Allen, and are very similar to those of Muriatic acid. The antidotes to Muriatic acid are Camphor and Bryonia for the dy- namic effects of the drug, and alkalies for its acute poisonous effects. Muriatic acid may also be used for the muscular debility following the prolonged use of Opium. LECTURE XLIX. PHOSPHORIC AND SULPHURIC ACIDS. ( Debility—Aphthae—Typhoid. Phosphoric and Sulphuric acids. < Haemorrhages. [ Diarrhoea. Phosphoric Acid. Phosphoric acid. < Rhus tox. China, Arsenicum, Veratrum. Nux vomica. Ferrum. > Camphor. Baptisia. To-day we have to study Phosphoric acid. This is a combination of oxygen with phosphorus. Phosphoric acid produces weakness or de- bility. Sometimes it causes a transient excitement, but the main characteristic of the drug is this debility, which is characterized by indifference or apathy, by torpidity of both mind and body, by com- plete sensorial depression. The patient is disinclined to answer your questions. His answers are short, consisting generally of "Yes" or " No," and are made in a way that show that it is annoying to him to speak. The delirium is quiet, not violent, but accompanied with this characteristic depression of the sensorium and muttering, unintelligible speech. He lies in a stupor, or in a stupid sleep, unconscious of all that is going on about him; but when aroused he is fully conscious. That is characteristic of the Phosphoric acid. You see it is depressing to the sensorium and to the body in general, and yet these changes are in a certain sense superficial. It does not seem to dip deep down into the tissues, so to speak, and affect those serious changes in them that call for some such drug as Lachesis. You w7ill find the quality above-mentioned pervading every Phosphoric acid symptom I shall mention. So, you would not expect to give the drug in advanced stages when the stupor is complete. Now the symptoms which indicate Phosphoric acid in typhoid fever are these: Pointed nose; dark blue rings around the eyes. The patient phosphoric acid. 497 may suffer from nose-bleed, but this nose-bleed, however, gives no relief to the symptoms in the early stages of typhoid fever. This is a very different symptom from Rhus tox., which is similar to Phosphoric acid. This has epistaxis in the beginning of typhoid fever, the patient being relieved by the haemorrhage. The patient bores his finger into the nose. Now it is not always advisable to remember Cina, and suppose because the patient is picking at the nose that he has worms. He may have itching of the nose. The symptom may also come from abdominal irritation. With Cina, it occurs from worms; with Phosphoric add, it is on account of the irritation of Peyer's patches, consequently you will find abdominal symptoms plentiful. For instance, the abdomen is apt to be distended and bloated. There is a great deal of gurgling and rumbling in the abdomen. There is often diarrhoea w7ith these symptoms. The stools are watery, sometimes involuntary, and contain undigested food. For instance, the milk which you have given your patient passes more or less undigested, and there is copious escape of flatus with the stool. The tongue is dry, and may have a dark-red streak down its centre; but it is apt to be pale and clammy, and some- times covered over with slimy mucus. Sometimes the patient bites the tongue involuntarily white asleep; this is a spasmodic motion; while the jaws come together the tongue protrudes. The urine you will find to be highly albuminous; it has a milky appearance, and decomposes very rapidly; you will find it also loaded with earthy phosphates. These are the main symptoms which would suggest the selection of Phosphoric acid in typhoid fever. The nearest remedies here are Rhus and Phosphorus. Phosphoric acid often follows Rhus after the latter has relieved the restlessness and the diarrhoea persists, and the patient goes into this quiet sort of stupor. Phosphorus has more dryness of the tongue, more sensorial excite- ment; all the senses are irritated; the patient cannot bear any noises or odors. If diarrhoea is present, the stools are blood-streaked and look like " flesh-water." In this sensorial apathy you should also remember the Sweet spirits of nitre. The patient lies in bed, perfectly indifferent to every one. He answers questions readily enough, but is apathetic. That is the condition in which Hahnemann gave Sweet spirits of nitre. I have found it to succeed when Phosphoric acid failed. Arnica is also to be placed by the side of Phosphoric acid. Like the acid, it has apathy or indifference. The patient does not seem to 32 498 A CLINICAL MATERIA MEDICA. know that he is as sick as he is. But the Arnica condition is a more developed state. The depression and stupor are more profound. He goes to sleep when answering your questions, showing you how over- powering is the stupor. Then, too, you have the petechiae or ecchy- moses common to this remedy, and, still later, involuntary stool and urine. Opium is, more than Phosphoric acid, a remedy for stupor when that stupor is progressive. It is only in the beginning of the Opium state that the patient can be aroused from sleep. The stupor goes en until no amount of shaking can bring the patient to consciousness. Breathing grows more and more labored and stertorous; the face, in- stead of being pale, sunken and hippocratic, as in the acid, is deeper red, almost a brownish-red. The browner the red, the more is Opium indicated. Another series of symptoms in Phosphoric acid are its emotional symptoms. Phosphoric acid is one of the best remedies we have for the bad effects of grief and depressing emotions, particularly for the chronic effects of disappointed love. It is here particularly indicated after Ignatia. Ignatia suits the acute symptoms and Phosphoric acid the chronic. Phosphoric acid is also indicated for homesickness. From the effects of grief the patient is sad; he often has hectic fever and flushing of the face, especially in the afternoon, evening or toward night. He has sweat towards evening, and complains of crushing weight on the vertex. That last symptom is very characteristic of Phosphoric acid. Now, we may carry these indications further than this. We all know how the emotions affect the body, how bad news affects the digestion, how mother's milk is made poisonous by some terrible emotion. We may find in Phosphoric acid a remedy for uterine and ovarian diseases which arise remotely from emotional causes. Thus you may use it in pro- lapsus uteri which seems to have been precipitated by depressing emo- tions. If you have other symptoms to aid you in its selection, then all the more promptly will you find both local and constitutional symptoms removed by its administration. In homesickness you may also think of Capsicum. Natrum mur. may be placed alongside of Phosphoric acid for the chronic effects of grief with the " vertex headache," sadness, weeping, emaciation, etc. Next, I would like to say a few words about the diarrhoea caused by Phosphoric acid. It is particularly indicated in diarrhoea which is pre- PHOSPHORIC ACID. 499 ceded by rumbling in the bowels. The stools are frequent and per- sistent. Particularly is it indicated in young persons who grow rapidly. But the diarrhoea, despite its frequency, does not proportionately weaken the patient. The mother will tell you that her child has had diarrhoea for six weeks, with a great deal of rumbling of flatus, and yet it does not seem to be much weakened thereby. The stool may contain undigested food, and it may follow a meal. The distinction between it and Cinchona lies in the fact that the Cinchona diarrhoea exhausts the patient excessively. Then another symptom of Phosphoric acid is, that the patient, though quite weak, is rested by a very short sleep. I presume that this action of the acid is owing to the stimulating effect of the Phosphorus it con- tains. Phosphoric acid is suited more to the remote effects of the loss of animal fluids rather than to the acute symptoms. Thus we find it indicated for the long-lasting effects of seminal emissions, whether occurring during sleep or when awake, with every effort at stool or urination or from excessive venery. The whole system seems to be weakened. The patient is dizzy, feels as if he would fall. There is another peculiar form of dizziness. On lying down he feels that the feet are going higher up than the head. The genitals are relaxed. The scrotum and testicles hang down flabby and relaxed. The penis has no power of erection, or erections are deficient. Semen escapes too soon during coitus. The patient complains of formication over the scrotum. The back and legs are weak, so that he totters when he walks. He has little or no absolute pain. There is burning in the spine, which is worse at night. Phosphoric acid is very similar to Cinchona, in fact it is superior to it in the chronic effects of loss of seminal fluid. Cinchona is useful for the acute effects. For instance, a man has emissions for three or four consecutive nights, and is thus much weakened; then Cinchona will relieve him promptly-. When you give Phosphoric acid for this relaxed condition of the genitals, give it low. In headache, Phosphoric acid occasionally comes into play, especially when the trouble occurs in school-girls; the headache comes on when they study and continues as long as they study. Phosphoric acid, furthermore, is to be thought of as a remedy for the debility arising from excessive study. Phosphoric acid also affects the mucous surfaces. We have to re- 500 A CLINICAL MATERIA MEDICA. member it particularly in chest affections. The cough arises from tickling in the chest, just about at the ensiform cartilage. It is worse in the evening after the patient lies down. In the morning we find expectoration, which is yellowish or muco-purulent, and usually tast- ing salty. We may think of it, although less frequently than of Phos- phorus, in cases of tuberculosis, when there is great weakness of the chest, so that the patient can hardly talk. This weakness seems to be a cause of dyspnoea. Every draught of air gives him fresh cold. He wraps his chest up warmly; he cannot bear a draught of air to touch his chest When these symptoms are present, the acid is superior to Phosphorus. Next, the action of Phosphoric acid on the bones. You may give it in scrofulous affections of children; for example, in hip diseases and in curvature of the spine from caries of the vertebra, when this symp-. torn is present: If the child is old enough he will complain of a feeling as if the bones were being scraped with a knife. This is from inflam- mation of the periosteum. It is worse at night. This symptom may occur after the abuse of mercury. Phosphoric acid, like all the mineral acids, affects the kidneys. It produces first what we may call polyuria or copious urination. The symptom, as it was produced in the prover, was this: The urine flowed so rapidly and so frequently that it came out as though the urethra was twice its natural size. You may see in Phosphoric acid a possible remedy for diabetes mellitus. The symptoms which lead you to it are, first of all, this frequent and profuse urination, requiring the patient to rise often at night. The urine is often milky in appearance. Sometimes it deposits jelly-like masses, particularly in catarrh of the bladder. I would also like to call your attention to Lactic acid. As a remedy in diabetes I have used it with great benefit. Phosphoric acid has been recommended for growing pains. Guaiacum is also said to be useful for these. Sulphuric Acid. C Arnica, Conium, Ruta. Sulphuric acid, -j Pulsatilla, Nux vomica. (_ Lachesis. > Pulsatilla. V Pulsatilla. SULPHURIC ACID. 501 Sulphuric acid is indicated when the patient is hasty, quick and restless in his actions, sometimes, too, when there is the opposite con- dition, one of great depression, as in typhoid states. He answers ques- tions slowly and with great difficulty, just as does the Phosphoric acid patient. You find that there is a general sensation of trembling in the Sulphuric acid patient. He feels as if he were trembling from head to foot. The face in these conditions is rather peaked and is apt to be pale with blue rings around the eyes. Sometimes there is a feeling as though white of egg were dried on the skin. The patient is particularly weak about the digestive organs; thus there is a cold, relaxed feeling about the stomach, making the patient long for some strong or stimu- lating drink, as brandy, and this, too, in persons who are not addicted to drink. So wreak is the stomach they vomit all food; the ejected matters are very sour. You will find Sulphuric acid especially indicated for inebriates who are on their " last legs." They have run down completely, and have long since passed the Nux vomica condition. You find them pale, shriveiled-looking and cold; their stomachs so relaxed as not to be able to tolerate any food. They cannot even drink water unless it contains whiskey. The liver is enlarged. They have a dry stomach cough, often followed by belching, the act of coughing hurting the liver. The diarrhoea is watery ar;d offensive, and is accompanied by excessive irritability of mind. They have a quick, hasty manner of doing every- thing. Piles annoy them. There is always dampness or oozing of moisture from the rectum. These piles burn, and are so large that they fill up the rectum. These cases are relieved by Sulphuric acid. There is another use we may make of Sulphuric acid, and it is derived from its power of modifying the thirst for spirituous liquors. You should take two or three drops of the pure acid and dissolve them in a glass one-half full of water. Give it to the inebriate every two or three hours in teaspoonful doses, and it will overcome the physical craving. Give it until he gets well, even if it produces a sore mouth. Should it produce diarrhoea, Pulsatilla is the proper antidote. Another effect of Sulphuric acid is its action in aphthous sore mouth occurring in debility arising from protracted disease, or in children with summer complaint or marasmus. The mouth is filled with yellowish aphthous spots. There is a profuse flow of saliva. With this there is apt to be vomiting of sour milk or sour mucus. The child smells sour despite the most careful washing. The stool is yellowish or slimy. It looks like chopped eggs. The child is very apt to have a cough, 502 A CLINICAL MATERIA MEDICA. which is very likely a stomach-cough, with belching of wind after the cough. You may think of Sulphuric acid also in diphtheria. The tonsils seem to be bright red and quite swollen. So swollen are they that liquids escape through the nose. The child is deathly pale, so pale that it looks like a corpse. It is inclined to drowsiness or somnolence. It can hardly breathe or talk, or make any noise on account of the abundance of membrane. Sulphuric acid is also useful as a traumatic remedy. It may be used for bruises of soft parts after Arnica; in bruises of glands after Conium ; in injuries of bones after Ruta. Particularly may it be used when there are long-lasting black and blue spots with soreness and stiffness. Again, Sulphuric, more than any other acid, is useful in haemor- rhages. It causes haemorrhage from every orifice of the body, the blood being dark and thin. You differentiate Sulphuric acid from Carbo veg. in the dyspepsia of drunkards by the fact that Sulphuric acid is more a '' sour remedy '' and Carbo veg. a '' putrid remedy.'' LECTURE L. NITRIC, HYDROCYANIC AND PICRIC ACIDS. Nitric Acid. Calcarea ostrearum, Kali carb., Lycopodium. Arsenicum, Carbo veg., Phosphorus, Moschus, Anti- Nitric acid. ■{ monium tart. Phosphoric acid, Muriatic acid. Hepar, Mercurius. V Arum triphyllum. Nitric acid. Erosion of the mucous membranes, worse where they join the skin. Offensive discharges. Ulcers, irregular, exhibiting exuberant granula- tions; worse from touch, from which they will bleed. Abuse of mercury. Typhoid. —Debility. Catarrh. [ Fibrous and osseous tissues. Nitric acid as a chemical substance need scarcely be explained to you, as you know its properties so well. I therefore pass on to con- sider its use as a medicine. You know its effects on the tissues, stain- ing the skin a dark yellowish-brown. It is a highly corrosive acid, eating into the flesh. Hence it has been used for the removal of warts, tumors, ulcers and exuberant granulations. It acts very powerfully on the mucous membranes, and has a par- ticular affinity for the outlets of mucous surfaces where skin and mucous membrane join. Hence you will find its symptoms about the mouth, lips, nostrils, meatus urinarius and anus; in fact, wherever skin and mucous membrane come together, there has Nitric acid a prominent action. 5Sesquioxide of iron. > China. > Ipecac. > Ferrum. > Graphites. > Camphor. >Veratr. alb. Irritability. Inflammations: stomach, uterus, etc. Fevers: continued, typhoid, intermittent. Skin: exanthemata, indurations, gangrene, carbuncle, cancer, ulcer. Nerves: neuralgia, convulsions, stupor, exhaustion, fainting. Catarrhs: eyes, nose, throat, lungs, etc. Dropsy; anasarca, hydrothorax. To-day we take up for study the last of the acid remedies. I refer to Arsenious acid or Arsenicum album. It has quite a number of con- cordant remedies, and quite a string of antidotes. Its complementary remedies are Phosphorus and Allium saliva. Arsenicum album comes to us quite thoroughly studied, both as a Arsenicum. < 320 A CLINICAL MATERIA MEDICA. poison and as a remedy. It has long been known as a speedy means of destroying life, hence it has been frequently used for suicidal and homi- cidal purposes. It has the property of uniting with animal tissues, probably with the albuminous portions of the tissues, hardening them and causing them to resist the usual process of decay, so that these tis- sues are long preserved. This fact is taken advantage of by taxidermists in stuffing birds and animals. Cases of accidental poisoning with Arsenic are quite common, and this is all the more so because of the use of Arsenic in the arts. In the form of Scheele's green, or arsenite of copper, it enters into the composition of certain paints. It is used frequently in the manufacture of certain green wall-papers, and also in artificial flowers. It is also introduced into pastes to be used in sealing packages, which are to protect goods from insects. All these uses of Arsenic render poisoning, especially chronic poisoning, by it not at all uncommon. In certain districts Arsenicum is indulged in as an article of diet. The women take it for the purpose of beautifying the complexion, and the men indulge in it because it enables them to work hard with little or no fatigue. The drug acts on muscular tissue so as to increase its power of endurance. We may make use of this fact when some disease has resulted, from climbing mountains or a long journey, as a pro- voking or modifying cause. The "Arsenic" vice is very objection- able, and certainly very injurious. After awhile these persons will suffer from Arsenic poisoning, especially if they move away from the region where they are living. The symptoms of slow arsenical poison- ing are these: Oedematous eyelids; the patient suffers from slight conjunctivitis; the eyes are always red and injected, and smart and burn. Associated with these symptoms is dim sight. Whether this comes from the inflammation externally, or from any internal ocular trouble, I am unable to say. The mucous membrane of the mouth, nose and throat is unnaturally red and dry. The sufferer complains of almost constant thirst. Digestion is most certainly deranged. The patient will tell you that he is dyspeptic. The skin assumes rather a dry, dirty look; it is only exceptionally clear and transparent. The patient suffers frequently from nettle-rash. Long wheals appear, and these itch and burn intolerably. Still later, eczema makes its appear- ance. The patient also suffers from stubborn neuralgia in different parts of the body. These are the most common, and the most certain symptoms indicating arsenical poisoning. In addition to these there will be some acute symptoms. For instance, there will be times when ARSENICUM. 521 the patient has attacks of vomiting, with deathly nausea. He will vomit everything he drinks. At other times he has symptoms indi- cating cholera morbus, e.g., vomiting and purging, and coldness of the surface of the body. You may frequently be called upon to antidote arsenical poisoning. If it is an acute case you should excite vomiting and administer the sesquioxide of iron as an antidote. Dialyzed iron has also been re- commended. It has the advantage of being more stable than the ses- quioxide. For the nausea occurring during chronic poisoning, Ipecac acts very nicely. In the acute attacks simulating those of cholera morbus, Veratrum album relieves. Cinchona also suits many of the symptoms, particularly the debility, dropsy and neuralgia. Graphites is one of the best remedies to cure the skin symptoms of chronic arsenical poisoning. Now we will consider the symptoms of Arsenicum in their totality. Quite a universal symptom of the drug, and that, too, whether the result of poisoning or of proving, is what I have already mentioned, an irritability of fibre. This is present and prominent in the worst cases in which Arsenicum may be used. Death may be almost certain, and yet there is this irritability of fibre showing the universal charac- teristic of the drug. Even when the patient lies in a stupor, this stu- por is broken by anxious moans and restlessness. Consistently with this quality of the drug, we find Arsenic indicated in patients who are anxious and restless, frequently changing their position, full of fear of death; hence they do not wish to be left alone for fear they will die. Delirium is violent, more violent than in any other of the acids except Nitric acid. It is worse at night, particularly after midnight. The patient has visions of ghosts and other fanciful figures, with trembling of the whole body. You cannot here fail to recognize the similarity to delirium tremens or mania-a-potu. Arsenicum here is of great use, particularly in old offenders who are seriously diseased by the use of alcohol, and who, from some cause or other, cannot get their usual drink. The pains which the Arsenicum patient experiences, whether neu- ralgic or otherwise, make him desperate and angry, almost furious, in fact. When falling asleep, he jerks and starts. During sleep his dreams are frightful and fantastic. Before going any further, I want to introduce a caution in regard to Arsenic. Arsenic is not a remedy usually called for in the beginning of diseases. The tendency of the 522 A CLINICAL MATERIA MEDICA. symptoms is deathward. If you give the drug too soon, in a disease which in itself tends deathward, you may precipitate the result which you are anxious to avoid. I have myself several times made the mis- take despite great caution. Do not give Arsenicum early in typhoid fever unless the symptoms call for it unmistakably. Here it is espe- cially dangerous to give it too soon. Often Rhus tox. precedes its use. I will say the same thing in regard to tuberculosis. In the last stages of this disease this restless tossing about is not an Arsenic symptom, and Arsenicum will not relieve it. That is only a precursor of death. You must be certain that the mental state is indisputably that of Arsenic, or you will do harm instead of good to your patient. There is one exception to this word of caution, and that is in inflammations of the gastro-enteric system. I may say that Arsenicum may here be given quite early in the case without doing any harm, on the contrary, with much benefit. Now for the inflammations and fevers of Arsenicum. Arsenicum alters the blood. It is useful, as we shall learn, in low types of dis- ease, when the blood-changes are serious. The inflammations of this remedy are characterized by their intensity, and by the tendency to the destruction of the tissue which is inflamed. In these local inflam- mations of Arsenic you will find burning lancinating pains the charac- teristic sensations. This is described by the patient as though hot coals were burning the part. It is often accompanied with throbbing. Now this burning when Arsenicum is the remedy indicates destruction of tissue, hence it calls for this remedy in gangrene, in sloughing, in car- buncles, and in that dreadful disease, cancer. And it does not call for Arsenic when this burning is a mere sensation. Patients occasionally complain of burning pains, here and there, which arise from nervous causes only. Arsenicum does no good then. I have often seen phy- sicians give Arsenic when women complained of burning pain in the ovaries. There was no evidence whatever of active inflammation, but there was this burning from ovaralgia. Arsenicum could do no good here. If, however, there is ovaritis w7ith this pain, Arsenic becomes an invaluable remedy. All these cases in which Arsenic is called for are relieved by hot applications, and greatly aggravated by cold. The most important sites for the Arsenicum inflammations are the stomach and bowels primarily, and next to these the heart. This in- flammation in the stomach and bowels may vary from slight irritation to the most destructive gastritis and enteritis. The mouth is dry, the tongue white as if whitewashed, or, in some other cases of irritable stomach, the ARSENICUM. 523 tongue is red with raised papillae. Thirst is intense, but the patient drinks but little at a time because water molests the stomach. An or- dinary amount of food causes a feeling of fulness or repletion. In this symptom it is similar to Lycopodium. The least food or drink is vomited as soon as taken. But we may have another group of symp- toms: Weak, sinking sensation at the pit of the stomach, relieved by eating, but so soon as he begins to eat, he has urging to stool w7ith diar- rhoea. Here the drug is similar to Cinchona and Ferrum. There is very distressing heartburn. Sometimes, burning in the stomach like coals of fire is associated with the diarrhoea. The stools are undigested, slimy, and bloody, and are attended with violent ten- esmus and burning in the rectum. If this goes on, the stools become brownish or blackish, and horribly offensive, showing that it is indicated in most serious cases of enteritis and dysentery. The exciting causes for these various sets of symptoms are sudden chilling of the stomach w7ith ice-water or ice-cream, alcoholic drinks in excess, certain poisons, as sausage meat that has spoiled, rancid fat, spoiled butter or fat that has undergone decomposition, and lobster salad at certain seasons of the year. Arsenicum also excites intestinal disease which is almost identical with cholera Asiatica. Even the organic growths of cholera are found in the discharges from the Arsenic proving. Do not conclude from this that Arsenic must be the remedy for cholera Asiatica It is only the remedy wThen we have the following symptoms: Intense vomiting and purging, the stools being not so much like rice-water as they are brownish-yellow, profuse, and offensive. The vomited matters are green, yellow, and bilious. There is burning thirst, with the intense agony which belongs to Arsenicum. The surface of the body is as cold as ice, but internally, the patient feels as if full of fire. Arsenicum is also useful in cholera infantum, and in atrophy of in- fants. It is indicated by many of the symptoms that have already been enumerated. The symptoms of the bowels are, undigested stool, diarrhoea which is provoked just as soon as the child begins to eat or drink, aggravation after midnight (particularly the restlessness and the diarrhoea), and rapid emaciation. The child's skin is apt to be harsh and dry, and often yellowish and tawny. The little patient is restless, evidently being in constant distress. Here, too, we often have to give Arsenic quite early in the case, because here the symptoms have been going on before your arrival. It stands in close relation with Nux vomica and Sulphur in atrophy of infants. For instance, early in the 524 A CLINICAL MATERIA MEDICA. case of marasmus, you may give Arsenicum, providing diarrhoea is present in a case which would call for Nux vomica or Sulphur were constipation present. The same dried-up mummy which you find in the Sulphur case, with the peculiar gastric symptoms of Arsenic, would call for the Arsenic. In far-advanced cases, the resemblance is not to these remedies, but to Cinchona, or China, and to Argentum nitricum. Now let us study some of the related remedies of Arsenicum in gastro-intestinal troubles. Argentum nitricum has slimy, greenish stools, with excessive flatu- lence, w7orse at night. Although both remedies have restlessness, it is not the same in each case. Arsenicum has a restless desire to change place, now sitting, now standing. The restlessness of Nitrate of Silver is purely nervous. The patient has difficulty in breathing, with long sighs. Much more frequently will you be called upon to differentiate between Arsenicum and Carbo veg. Carbo veg. is somewhat similar to Arsenicum in abdominal affections arising from chilling the stomach, as with ice-water. It has, perhaps, less of the distinctive restless tossing about, but at the same time it may have a nervous, irritable, anxious state, without tossing about. Carbo veg. is also a similar remedy to Arsenicum when rancid fat has excited gastro-enteric symptoms. Secale cornutum is very similar to Arsenicum in many of its symp- toms. The two drugs are complementary. They agree well one with the other. In the abdominal symptoms both drugs meet in cholera Asiatica. Arsenicum may be distinguished from Secale by these few symptoms: The movements in Secale are copious and come in spurts; Secale has not the same restlessness that belongs to Arsenicum. Now, when there are any spasmodic symptoms present, as is often the case, you will find, under Secale, fingers spread asunder, with tingling in the hands and feet. Veratrum album is somewhat similar to Arsenicum in cholera morbus. The latter has not so copious a stool as the former. Cold sweat on the forehead is more marked in the Veratrum. Do not forget that Cadmium sulphuricum is similar to Arsenicum in black vomit, whether that symptom occur in yellow fever or in any other disease We find Arsenicum often indicated in intermitting types of fever. We all know how often Arsenic succeeds Cinchona in the treatment ARSENICUM. 525 of chills and fever. It often cures. It is especially indicated after the failure of Quinine, or after the abuse of that drug; also when the fever has been contracted in salt marshes along the seashore. The chill is not well defined; in fact, it is rather irregular, but the heat is unmis- takable. It is intense, with burning thirst, especially for hot drinks; cold drinks make the patient feel chilly. Sweat does not always relieve. Sometimes it appears very tardily. The apyrexia is marked by severe symptoms, dropsy showing itself as the result of enlarged spleen or liver. The patient is scarcely able to sit up. He is often annoyed by neuralgia, this neuralgia being typical in its appearance. The pain usually affects one side of the face and seems to be almost maddening, driving the patient from place to place. At the height of the attack there are nausea and vomiting and buzzing in the ears. Arsenicum may be also used in intermittent, semilateral headache of malarial origin, especially after the abuse of quinine. There are several drugs similar to Arsenicum in these malarial neu- ralgias. Cedron has neuralgia, returning at precisely the same hour each day. Chininum sulphuricum is also suited to periodically recurring attacks of neuralgia. Valerian is to be thought of in hysterical patients. Cactus grandiflorus has neuralgic and other forms of pain, which are sure to appear when the patient misses an accustomed meal. Kalmia and Kreosote are useful in neuralgia, especially when there are burning pains. Magnesia phos. is called for in neuralgia which occurs regularly each night. Mezereurn has neuralgia in the cheek-bone or over the left eye. The pains leave numbness. They are worse from warmth. It is espe- cially useful wThen there have been herpetic eruptions after the abuse of mercury. It is one of the remedies we use for the neuralgia of zona. Robinia has: jaw-bone feels as if disarticulated. With this there is intensely sour taste or vomiting. Other remedies to be borne in mind are Cinchona, Spigelia, Platinum, Stannum and Chelidonium. In typhoid fever Arsenicum is indicated late in the disease, when the blood changes have so far progressed that you have a picture of complete exhaustion. The patient thinks himself still able to move about until 526 A CLINICAL MATERIA MEDICA. he finds out how weak he is. He has fainting attacks, which are very alarming; he faints dead away, with cold sweat on the body. The delirium is worse after twelve p. m. , and is attended with great restless- ness. He is sleepless at three A. m. on account of the great heat. The mouth and tongue are covered with sordes, and with a dark brownish coating. Sometimes the tongue is very red. Around the dorsum and tip of the tongue you will find the papillae red and raised, as under Belladonna, but the concomitant symptoms enable you to differentiate it from that remedy at once. The mouth is full of blisters and aphthous ulcers which bleed readily. In other cases, the tongue is bluish with ulcerated edges. Sometimes, in severe cases, water cannot be swallowed because of partial paralysis of the oesophagus. You do not often find much tympany in the Arsenic case. The bowels are very much dis- turbed. Diarrhoea is almost always present, and seems to be provoked by every attempt to eat or drink. Sometimes, stool and urine are in- voluntary. The stool is yellowish and watery in character, horribly offensive and worse after midnight. At other times the stools contain blood, slime and pus. In some cases the urine is retained from atony of the muscular fibers of the bladder. The fever is intense, being almost sufficient to consume the patient. Sometimes, you have the haemorrhagic diathesis to deal with, and there is oozing of blood from various parts of the body, from the eyes, nose, etc. This is a dangerous symptom. Colchicum is a remedy which we are very apt to neglect in typhoid fever. It seems to stand in typhoid conditions between Arsenic and Cinchona, having the excessive weakness of the former remedy and the marked tympany of the latter. The chief symptoms of Colchicum are abdominal. They are, this great tympany, involuntary, forcible, watery stools, accompanied with nausea and frequent vomiting of bile. The body is hot and the limbs are cold, just as in Phosphorus. The nose is dry and blackish. The teeth and tongue are both brown. The mind is somewhat cloudy. He answers questions correctly, but otherwise says nothing. He seems not to know the danger he is in. The relations of Arsenic to other remedies in typhoid fever have been described to you elsewhere. I need not, therefore, repeat them here. Arsenicum may also be useful in continuous fever, which, in its early stages, so closely resembles that of Aconite, that you may not be able to distinguish between the two drugs. There are hot skin, ARSENICUM. 527 full bounding pulse, restlessness and anxiety. Thus far, it is exactly like Aconite. But it does not end here. It goes on to a continuous type of fever without any intermissions, and with only slight re- missions. The heat increases, the patient grows more restless and yet weaker, the tongue becomes brown and typhoid symptoms de- velop. Now, the distinction between Arsenic and Sulphur is easily made. Sulphur is also useful in continuous fever. Arsenic is indicated when the great restlessness and burning show you that the case has gone be- yond simple continuous fever. Now, the action of Arsenicum on the mucous membranes. We find it an excellent remedy in winter colds. The nose discharges a thin, watery fluid, which excoriates the upper lip, and yet the nasal passages feel stuffed-up all the time. This is accompanied by dull throbbing frontal headache. Repeated attacks of this kind of catarrh or coryza, result in the discharge of thick, yellowish, muco-purulent matter. Ulcers and scabs form in the nose. Sneezing is a prominent symptom. Now this sneezing in the Arsenic case is no joke. It does not give the relief which one usually gets from a good sneeze. It is a sneeze which starts from irritation in one spot in the nose as from tickling with a feather. After the sneeze, this irritation is just as annoying as it was before. As the cold creeps downwards, you find the case complicated with catarrhal asthma. Dyspnoea appears. The patient cannot lie down, particularly after midnight. He is greatly relieved by cough with expectoration of mucus. You will at once recognize the similarity between the symptoms of Arsenic and those of hay fever. Other remedies which you may re- member for this condition are: Ailanthus, Silicea (which has itching or irritation in the posterior nares or at the orifices of the Eustachian tubes), Lobelia inflata, and a remedy introduced by the late Dr. Jeanes, Rosa Damascena. This Rosa Damascena is useful in the beginning of rose-cold when the Eustachian tube is involved and there is some little hardness of hearing and tinnitus aurium. Sinapis nigra is indicated when the mucous membrane of the nose is dry and hot. There is no discharge. The symptoms are worse in the afternoon and evening. Either nostril may be affected alone or alter- nately with the other. In diphtheria, Arsenicum comes into use as a most valuable drug. Arsenic crude kills the microscopic growths which produce the dis- 528 A CLINICAL MATERIA MEDICA. ease. In its potentized state it cures when there is foetid breath, ady- namic fever and a great deal of somnolence. This sleepiness is broken by starts, crying out and by jerking of the limbs. The membrane looks dark and is gangrenous. The pulse is rapid and weak. I would advise you to substitute Arsenicum iodatum, if, in addition to the usual Arsenicum symptoms, there is marked enlargement of the lymphatic glands. I have stated that Arsenic acts on the heart. It gives us a list of cardiac symptoms which are, in brief, these: The heart-beat is too strong, it is visible to the person standing by and is audible to the patient himself. It is worse at night and is particularly aggravated when the patient is lying on his back. There may be palpitation with great irregularity of the heart's action. Or the pulse may be accelerated and weak. In cardiac inflammations, endocarditis or pericarditis, we find Arsenic in- dicated after the suppression of measles or scarlatina. You then find present the characteristic restlessness and agony of the drug, tingling in the fingers especially those of the left hand. CEdema is more or less general, beginning with puffiness of the eyes and swelling of the feet and ending with general anasarca. There is great dyspnoea. Now there are two varieties of dyspnoea which belong to heart dis- ease, one which depends upon the defective carrying of the blood through the lungs and the system generally, and the other which is due to accumulation of water in the chest, hydrothorax and hydroperi- cardium. There are spells of suffocation, worse at night, particularly after midnight and on lying down. The skin is cool and clammy, while internally, the patients are burning hot. Now if this condition calling for Arsenic goes on uncured, Bright's disease of the kidneys develops. The urine is highly albuminous and contains waxy and fatty casts. Dropsy appears. Little blisters appear on the legs and these burst, and serum oozes from the oedematous limbs. The skin itself is rather tense and has a palish-waxen hue. Exhausting diarrhoea seems to accompany these symptoms. There is very apt to be also a burning thirst with intolerance of water. I wish you now to recall the comparison that I have already given you between Arsenicum and Apocynum, and Acetic acid, which stands midway between Arsenicum and Apis. I would also have you recall the similarity between Arsenicum and Mercurius sulphuricus in hydro- thorax. In kidney affections you may compare Arsenicum with Apis, Helle- borus, Phosphorus, Aurum, Terebinthina and Digitalis. ARSENICUM. 529 Now the Digitalis symptoms are these: There is venous hyperaemia of the kidneys. You are to study it, therefore, in renal affections when there are present dropsy, feeble or slow pulse, scanty dark turbid urine, which will, of course, be albuminous. It is exactly like Arsenic, with- out the restlessness and irritability of that remedy. Again, we find Arsenicum indicated in that dreadful disease, angina pectoris. The patient is obliged to sit upright; he cannot move the muscles of his body without great suffering. He holds his breath, so painful is it for him to breathe. Pain seems to radiate from the heart all over the chest and down the left arm. In extreme cases there is cold sweat on the forehead, the pulse becomes scarcely perceptible, and, with all this, there is apt to be burning around the heart. I would now7 like to refer to the action of Arsenic on the skin. You have already seen that it tends to produce induration or harden- ing of the skin. This renders it a valuable remedy in eczema, in fact, in every variety of the skin in which there is thickening of that structure, with copious scaling. Arsenicum is also useful in eczema proper, when vesicles appear which turn into pustules and form scabs. Arsenicum is specifically indicated for bran-colored scales on the head, coming down over the forehead. It may also be indicated when there is a thick scabby eruption on the scalp, oozing pus, and very offensive. Arsenicum compares with Sepia, Rhus tox., and Graphites. Like Sepia there is a dry scaly desquamation, but in Sepia this "peeling" follows vesicles which were not surrounded by very red skin, or it follows a fine rash, worse about the joints, or a circular eruption like herpes circinatus. Rhus tox., has vesicles on a red erysipelatous surface. Graphites looks very much like Arsenicum, but with oozing of a glutinous fluid. Clematis is similar to Arsenicum, but has more rawness, aggravation from washing and moist, alternating with dry scabs. In the exanthematous diseases we find Arsenicum indicated first of all in urticaria. Here it is a valuable drug when the wheals are at- tended with burning, itching, and restlessness. Particularly may it be indicated for the bad effects of repercussion of hives. Even croup may be cured by Arsenic if it follows the retrocession of nettle-rash. In scarlatina Arsenic is to be used in some of the worst cases when the rash does not come out properly. The child is thrown into con- 34 53Q A CLINICAL MATERIA MEDICA. vulsions, and lies pale and in a sort of stupor. It is very restless, moaning during the stupor. Suddenly it seems to arouse, and imme- diately goes into convulsions, and then relapses again into this stupor. It is also useful when, during the course of scarlatina, the parotid glands swell and suppurate, after the failure of Rhus. Arsenicum is useful in gangrene, particularly in the dry gangrene of old people, with great soreness and burning in the affected part, with relief from warm or hot applications. This modality furnishes you with a sufficient distinction between Arsenic and another great gan- grene remedy, Secale, which is useful in gangrene, with relief from cold applications. We may use Arsenicum in carbuncles or in boils with pepper-box openings in them, and dipping deeply into the cellular tissues. It is indicated by the character of the pains, which you know run all through the Arsenicum symptoms, cutting lancinating pains, with aggravation after midnight, and irritability of mind and body. Arsenicum sometimes fails in carbuncles. Then we have to resort to Anthracinum, chiefly in the thirtieth potency. It has precisely the same symptoms as Arsenicum, but to a more intense degree. Carbo veg. and Lachesis are remedies that we neglect in this disease. If we use Carbo veg. it is well also to use a charcoal poultice over the carbuncle. Arsenicum may be used in cancer. I am not going to propose that this drug will cure cancer. Epithelioma has been cured by Conium, Hydrastis, Arsenic, Clematis and a few other remedies. But in cases of genuine open cancer I have not seen any cases cured; but even if these cases cannot be cured, it is still possible to give them some relief. The pains of cancer you know to be torture. They are of a sharp lancinating character; a red-hot knife thrust into the part could not be worse. Arsenic sometimes relieves these, sometimes it does not. Sometimes Belladonna brings relief. In some cases Arsenicum iod. relieves when Arsenicum album fails. The ulcers for wThich Arsenicum may be given are not usually very deep. They are rather superficial. The pains are of the character already described, burning and lancinating. The discharge is apt to be excoriating, dark and sanious. They are apt to bleed very readily. Lastly, we will consider Arsenicum as a remedy in nervous affec- tions. It is indicated in hemicrania when the pains are worse over one ARSENICUM. 531 eye, and are of a severe lancinating character. They often alternate with colic or affections of the liver. They are worse from any motion, and are temporarily relieved by cold applications. It may also be used in epilepsy. The patient falls down uncon- scious, and then writhes in convulsions. Before the attack he has spells of vertigo and intense aching in the occiput. The convulsions are followed by stupor, which, however, is not complete, but is broken by restlessness. LECTURE LIU. PHOSPHORUS. Phosphorus. Nux vom., Coffea, Ambra. Rhus tox., Muriatic acid, Lachesis. Carbo veg., Arsenicum, Nitric ac, Kali carb. China, Veratr. alb. Sulphur, Calcarea ostr., Silicea, Lycopod., Calcarea phos. Cepa, Bryonia. Zinc. Terebinthina. Osmium. >Nux vomica, Terebinthina. < Causticum. This hour I wish to say a few words about Phosphorus. It has two complements, Arsenicum and Allium cepa. I have placed Nux vomica and Terebinthina as the antidotes. The use of Terebinthina comes to us from the old school. It seems to antidote Phosphorus by chemical action in rendering it inert. It also has antidotal effects when used in potency. Nux vomica is good when Phosphorus, as a remedy, has produced over-effects, or when it has been incorrectly given. In the study of Phosphorus we have to remember, first of all, as most important and as a quality that permeates every part of the Phos- phorus proving, its action on the nervous system. Its symptoms in no instance point to increase of power or vitality, or to any genuine stimu- lation of function, but rather to that condition which we found under Arsenic, irritable weakness. The patient is exceedingly susceptible to external impressions. He can bear neither light, sounds nor odors. He is very sensitive to the touch. Electric changes, such as occur in sudden changes of weather, but particularly in a thunder-storm, make him anxious and fearful, and aggravate all existing symptoms. His mind too is excitable and impressionable. He is easily angered and becomes vehement. This is not a simple peevishness. He actually gets beside himself with anger, and, just like the Nux patient, he suffers physically PHOSPHORUS. 533 in consequence. At other times he is anxious and restless, especially in the dark or about twilight. He has all sorts of fanciful or imagi- nary notions. He sees faces grinning at him from every corner of the room. His thoughts may be increased so that they fairly rush through his mind; but this effect is only transient, and is followed either by inability to think and remember, or by aggravation of all his symp- toms on mental exertion. He cannot stand mental tax. Here again it impinges on Nux vomica. As further evidence of the irritable weak- ness of Phophorus, we have the delirium of that remedy. Now this delirium may be associated with typhoid fever, with jaundice, or with sexual erethism. It may be quite violent. It is characterized by a^ Arsenicum, Hepar. Ranunculus bulbosus. ^ iEthusa cynapium. In the above schema I have placed no complementary remedy to Antimonium crudum. Scilla has been said to be complementary to it, but I have not satisfied myself that such is the case. When Antimonium crudum is indicated, we find mental symptoms quite prominent. It is frequently used in children when they are cross and peevish. They will not even permit themselves to be looked at. If an adult, the patient is sulky or sad, almost like the Pulsa- tilla patient. In some cases, there is a slightly erotic condition of mind, connected with sexual erethism. The patient becomes ecstatic 548 A CLINICAL MATERIA MEDICA. and fancies that some beautiful female is the object of his sentimental love. In children, this peevish mental state is associated with nausea, hot and red face and irregular pulse. The child is particularly cross when washed in cold water, but not so much in warm water. Now, the symptoms often occur in children in association with gastric symp- toms. The gastric symptoms of antimony are very well marked. It is suited to gastric catarrh, whether it be developed from cold or from improper food. In the first place, the tongue is coated white, and this coating is apt to be spread uniformly over the whole dorsum of the tongue. It has well been compared to a coat of whitewash. The tongue may be dry, and often is so, as in Bryonia. Sometimes, we find this white coating assuming a slightly yellowish tinge, especially on the back part of the tongue. At other times, you will find the borders of the tongue sore and red; often, there is in the pharynx an accumulation of yellowish mucus. There are nausea and vomiting; the latter is very prominent, and occurs as soon as the child eats or drinks. Antimonium crudum is especially useful in vomiting from overloaded stomach; from eating indigestible substances; after the abuse of fat food, acids, sour wines, vinegar, etc., or from the excessive heat of summer. The vomited matters contain food; or, in the case of very young children, they consist of curdled milk. The appetite is impaired. There may be colic, in which case there is almost always a deposit of lithic acid in the urine. The bowels are affected also; there is often diarrhoea; the stool is watery and contains little lumps of faecal matter. This diarrhoea is made worse by vinegar and other acids, by cold bathing and by overheating. If there is constipation, as there may be and often is when vomiting predominates, the stools will consist of white, hard and dry lumps that look like undigested curd. In older persons, par- ticularly in the aged (for Antimonium crudum suits both ends of life), we have an alternation of constipation and diarrhoea: the stool, in con- stipation consisting of hard, dry lumps; that in diarrhoea, of water mixed with faecal lumps. Now let us make some distinctions between Antimonium crudum and its concordant remedies. ALihusa cynapium is our mainstay for vomiting of curdled milk in infants during dentition, or at other times. The vomited matter comes with a " rush," and the vomiting exhausts the little patient. He then falls into a sleep from which he awakens hungry. In Antimonium crudum, the child is hungry as soon as it ANTIMONIUM CRUDUM. 549 rids itself of the milk. sEthusa is suited to severe cases that have been prostrated by a long course of bad diet, by summer complaint or by the irritation of teething. I have known sEthusa to relieve the pain and soreness in the gums of teething children when vomiting is a prominent symptom. Like Antimonium crudum, Ipecacuanha has vomiting after a meal, after coughing and after acids; and hence it is suited to similar cases. But the Ipecacuanha usually has more nausea than has the other. Vom- iting and retching predominate in Antimonium crudum, and nausea in ipecacuanha. Then, too, the latter remedy usually has clean or slightly coated tongue; whereas the former requires a thick white coating of that organ. Bryonia is similar to Antimonium crudum. It has white tongue, dry mouth and constipation. It is suited to gastric catarrh from over-eating in persons of irritable temperament. The Bryonia tongue is a little dif- ferent from that of Antimonium crudum, in that it is white down the middle, the edges not being coated. Then, too, the Bryonia stool is large, hard, dry and brown. If there is diarrhoea, the stool is offensive and watery, and smells like old cheese. Still another remedy is Pulsatilla. Here we find resemblances in the state of mind. We have both remedies called for in gastric ailments from the use of pork. But Pulsatilla has not the characteristic vomit- ing of antimony, and the stool of Pulsatilla is usually greenish, or yel- lowish-green, and slimy. It is especially suited to cases after indulgence in mixed diet—ice-cream, cakes, pastry, etc. Antimonium crudum acts upon the skin, producing thick, horny cal- losities in this tissue. It is often indicated in eczematous eruptions, when the skin is of this character. It also has a marked action on the nails, causing deficient growth. If, after an accident which has split the nail, the latter does not heal readily, but. grows cracked and thick, Antimonium crudum will make it grow as*it should. I have also used the drug successfully in the treat- ment of split hoof, in the case of my own horse. Children in Antimonium crudum often have a crusty sort of eruption, in which the crusts are of a honey-yellow color. They are thick, just as we have seen with the callosities. The affected portions of the skin crack readily. This is particularly well-marked about the nostrils and corners of the mouth. Now, I know of one case of diphtheria cured by Antimonium crudum when the symptoms were these: The child was very cross; whining and crying simply because it was looked at; this 55° A CLINICAL MATERIA MEDICA. was especially so on awaking from sleep; there were, also, these crusts around the nostrils and in the corners of the mouth. Antimonium crudum not only removed these but cured the diphtheria. The eyes are inflamed. They are worse from any bright glare, as the sunshine, or the glare of a bright fire, here reminding you of Mercurius. It is distinguished from Graphites by the fact that the rawness is con- fined to the canthi, whereas under Graphites the inflammation involves the whole border of the lids. On the female genital organs Antimonium crudum has some action. It is useful in prolapsus uteri when there is constant bearing-down feel- ing, as if something were pushing out of the vagina, and tenderness over the ovarian region, particularly when the menses have been sup- pressed by cold bathing. The leucorrhcea is watery and contains little lumps. There is one more use of Antimonium crudum to mention and we are done with it, and that is in adults who are tormented with gout. It is especially useful when gout has become constitutional. There will be gouty nodes in many of the joints. It here helps, provided there are the gastric symptoms characteristic of the remedy present, but not otherwise. Antimonium Tartaricum. Baryta c., Lachesis. _, , Ipecac, Kali hyd. Throat and I _,, . 011 r^ u \ Phosphorus, Sulphur, Carbo v. Laurocerasus, Ammonium carb. ( Bromine, Iodine, Spongia. Skin.—Conium, Mercurius, Kali bi., Kali hyd. Bowels.—Veratr. alb., Merc. Antimonium tartaricum or Tartar emetic, as it is also called, is a com- pound salt of antimony and potash, both of which substances depress the circulation. Hence you will expect to see symptoms due to this cause intensified under Antimonium tartaricum. It causes more weak- ness of the heart and lungs than does antimony itself. Under Antimonium tartaricum we find the head confused, with warmth of the forehead and confused feeling, as if the patient ought to sleep. This drowsiness is worse in the forenoon. Often there is a headache, with sensation as if a band were tied around the forehead. This is a common headache in passive congestion of the brain. You Antimonium tartaricum. antimonium tartaricum. 551 find it under Gelsemium, Mercurius, Carbolic acid, Sulphur, and sev- eral other remedies. Cool air and moving about seem to brighten the patient up. Bathing the head relieves; this is rather contrary to Antimonium crudum. There is sometimes throbbing, particularly in the right side of the head. Still another form of headache is drawing in the right temple, extending down and into the jaw-bone. This is a sort of rheumatic tearing pain in the periosteum. If the patient is a child we note an unwillingness to be looked at or touched. If you persist in your unwelcome attention it will have convulsions. On awaking from sleep the child seems stupid, and is so excessively irri- table that he howls if one simply looks at him. Vertigo is often an accompaniment of the Antimonium tartaricum ailment; this vertigo seems to alternate with drowTsiness. We often find Antimonium tartaricum indicated in cases of sup- pressed eruptions when there result these symptoms of the head. Par- ticularly is it called for when the eruption of scarlatina, measles or variola does not come out properly, or has been repelled; then we have, in addition to the symptoms I have already mentioned, great difficulty in breathing. The face is bluish or purple, the child becomes more and more drowsy and twitches. There is rattling breathing. All of these symptoms indicate a desperate case. Antimonium tartaricum will frequently restore the eruption and save the child. Now, these symp- toms that I have mentioned accompany two grand sets of phenomena for which Antimonium tartaricum may be useful, namely, pulmonary and gastro-enteric affections. For children it is an invaluable drug in diseases of the chest. You find it, for instance, indicated in wdiooping-cough, and, in fact, in any cough, whether from dentition or other causes, when the cough is pro- voked whenever the child gets angry, which is very often. Eating brings on the cough, which culminates in the vomiting of mucus and food. Again, there is another form of chest trouble in which it is indicated. A nursing infant suddenly lets go of the nipple, and cries as if out of breath, and seems to be better when held upright and carried about. Now, this is the beginning of capillary bronchitis. There are fine sub- crepitant rales all through the chest. Antimonium tartaricum here nips the whole disease in the bud and saves the child much suffering. Again, there is another form of cough in which it may be used. There is marked wheezing when the child breathes. The cough sounds loose, and yet the child raises no phlegm. This symptom increases until the 552 a clinical materia medica. child grows drowsy. Its head is hot and bathed in sweat. The cough then grows less and less frequent. The pulse is weak. Symptoms of cyanosis appear. The quicker, in these cases, you give Antimonium tartaricum, the better for your patient. Now for a few of the concordant remedies in these cases. I will first say, in addition to what I have already said, that Antimonium tar- taricum is also indicated in affections of old people, and particularly in orthopnce^a, or threatening paralysis of the lungs in the aged. You hear loud rattling of phlegm in the chest, and yet the patient cannot get up the phlegm. Here Baryta carb. is complementary to Antimo- nium tart., and often succeeds when the latter remedy only partially relieves. Ipecacuanha often precedes Antimonium tartaricum in catarrh of the chest in children. Loud rales are heard through the chest. When they cough they gag, but raise but little phlegm. In this threatening paralysis of the lungs you must compare Anti- monium tartaricum with several other drugs; with Lachesis, which has aggravation when arousing from sleep; with Kali hydriodicum, especially when there is oedema pulmonum and a great deal of rattling of mucus in the chest. What little sputum is raised is frothy and greenish, looking like soap-suds. Carbo veg. also suits these cases, but here the rattling is accompanied by cold breath and by coldness of the lower extremities from the feet to the knees. Moschus in paralysis of the lungs, when there is loud rattling of mucus and the patient is restless. It is especially indicated after typhoid fever. The pulse grows less and less strong, and finally the patient goes into a syncope. Also, do not forget Antimonium carb. in this condition. Antimonium tart, is indicated in the asphyxia at the beginning of life, asphy7xia neonatorum, when there is rattling of mucus in the throat. Laurocerasus is useful in the asphyxia of new-born children w7hen there is great blueness of the face, with twitching of the muscles of the face, and gasping without really breathing. Antimonium tartaricum produces a perfect picture of pleuro-pneu- monia. Certain portions of the lungs are paralyzed. Fine rales are heard, even over the hepatized portions. There is great oppression of breathing, particularly towards morning. The patient must sit up in order to breathe. It may also be indicated in bilious pneumonia, that is, pneumonia with hepatic congestion and with well-marked icterus. antimonium tartaricum. 553 The pit of the stomach is very sensitive to touch or pressure. There are meteorism, nausea and vomiting. It may be used in the pneumonia of drunkards w7ith these complications. Antimonium tartaricum produces pustules very nearly identical with those of small-pox; hence, it may7 be a very useful remedy in that dis- ease. It is very useful in the beginning before the eruption appears, and the patient has a dry teasing cough, which, under other circum- stances, might suggest Bryonia. Here, however, you should give Anti- monium tart., because it covers all the symptoms. It suits the cough and also the reason for the cough. It also suits the eye symptoms which occur during eruptive diseases, as small-pox, scarlatina, measles, etc. In diseases of the intestinal tract we find it indicated by the follow- ing symptoms: Nausea with great anxiety, eructations tasting like rotten eggs, yawning and drowsiness. The vomited matters are green and watery, and sometimes frothy, and contain food. The vomiting itself is associated with trembling of the hands, and is followed by drowsiness. Vomiting and purging may take place, with every symp- tom of collapse, coldness of the surface, the hands and feet are like ice, and the stools are profuse and watery. Thirstless or drinking little and often. Desire for acids, fruits, &c, cutting colic. Here you have an almost perfect picture of Veratrum. The distinction between the two remedies is that Veratrum has more cold sweat on the forehead, and Antimonium tart, more drowsiness. When Antimonium tart, has produced pustules, the antidote is Co- nium. LECTURE IvV. THE PREPARATIONS OF MERCURY. "" r Hepar. Mercurius vivus and solubilis. Cinch. dulcis. Nitr. ac. corrosivus. Dulc. aceticus. \ Kali hyd protoiodatus. >■ / Aurum. " biniodatus. / Asafcet. " cyanatus. Staph. Cinnabaris. Lach. Mercurius sulph. Iodine. praecip. rub. Mezer. 1 Stilling. We begin this morning with the study Of Mercury and its combi- nations. Mercury has long been known and used as a medicine in the old school of practice. Its abuse, when given in excess or inappropri- ately, has rendered it a very unpopular remedy among the laity. There are many physicians in the so-called old-school practice who have en- deavored to obtain for Mercury a substitute which would answer the same purpose without deleterious results. They have been more or less successful, but they have never really obtained anything equivalent to that remedy in its genuine usefulness. Of late days, there are not so many allopathic physicians who give the great doses of Mercury that used to be so common. This caution in its administration is no evi- dence of improvement of the medical world, scientifically speaking, but only that they have been driven to this course by their unfortunate results and by popular clamor. There are many physicians who are afraid to let their patients know that they are taking mercurials. The eclectics have substituted such plants as Podophyllum and Leptandra for Mercury, especially in liver affections. We, of the homoeopathic school, are not afraid to use mercurials, because we do so according to a fixed law, guided by their effects on the human system; therefore, we are not in any danger of the bad THE PREPARATIONS OF MERCURY. 555 results which follow overdosing or misapplication of the drug. You notice that I have placed on the board a number of mercurial prepa- rations. All of these have some medicinal properties, but we have not the time, nor will it be proper, to dwell on them all. Our main object is to treat of the principal actions of Mercury in general, and then to teach you the principal characteristics which will enable you to prefer one of these preparations rather than others. From the gen- eral character of the patient, you know that he needs some mercurial preparation, and you want to know which one. We have here two preparations, Mercurius vivus and solubilis, that I have placed on the same line. I do not know enough to separate them symptomatically. The provings have been separately placed in Allen's Encyclopcedia, but I have not been able to separate them. These preparations are the quicksilver, or metallic Mercury, and the Soluble Mercury of Hahne- mann. Mercurius solubilis is not a pure mercurial prepaiation. It contains some Ammonia and some Nitric acid. There are only traces of Nitric add, however, and yet these traces must modify its symp- tomatology somewhat, but to what degree I do not know. The prov- ings of " the solubilis " are excellent. They are complete, much more so than those of quicksilver. These latter are collected more from poisoning cases and from clinical cases than from actual provings. If, then, the symptoms are clearly placed in the Encyclopcedia under Solu- ble Mercury, I would advise you to use that preparation. Below the Mercurius vivus and solubilis on the board we have two preparations of Mercury w7ith Chlorine. Next comes Mercurius aceticus, of which we have but few symptoms. Next we have the two Iodides of Mercury, which are very important. The Biniodide is red, the Protoiodide, yellow. Then we have the Cyanide of Mercury. Next we have Cinna- baris, w7hich is the Sulphide of Mercury. Beneath this we have the Sulphate of Mercury, and then the Mercurius prcecipilatus ruber. Of these we have but few symptoms. Cinnabaris, the two iodides, the corrosivus, the solubilis and the vivus are the most frequently used. You see here on your right a list of antidotes to Mercury. That is in itself evidence of the numerous ill-effects which may result from its abuse. They are not all equally well indicated. As I mentioned the other day, Hepar is the most important antidote for Mercury, and also for many of the other metals. It is useful for the mental symptoms that may follow a course of Mercury, the anxiety, distress, and even the suicidal mood; also for the bone pains, sore mouth, ulcers and the gastric symptoms. 556 A CLINICAL MATERIA MEDICA. Nitric acid is particularly to be remembered when the lower tissues are attacked, as the periosteum, the bones and the fibrous tissues. The patient has bone-pains worse at night, aching in the shins in damp weather, ulcers in the throat; particularly if secondary syphilis is com- plicated by mercurial poisoning. Cinchona is said to antidote the chronic ptyalism produced by Mer- cury. Dulcamara has been successfully used for the salivation of Mercury, particularly when it is aggravated with every damp change in the weather. Kali hydriodicum, or the Iodide of Potassium, is a well-known antidote for Mercury, and has come into practice of late years, and is given by both schools of medicine very extensively, whether the case be syphilitic or not. Like Nitric acid, it is particularly indicated when syphilis and Mercury combine to make the patient sick, particularly when the lower order of tissues are involved, as the bones, the perios- teum and the glands; when there is the well-known syphilitic ozaena, thin watery discharge from the nose, making the upper lip sore and raw. You will find it the best drug we have for the repeated catarrhs which may follow the abuse of Mercury. Every little exposure to a damp atmosphere, or even to cool air, causes coryza. This, remember, is a case of mercurial poisoning which the Iodide of Potassium is to antidote. The eyes are hot, and watery, and swollen. There are neu- ralgic pains in one or both cheeks, the nose feels stuffed up and is swol- len, and discharges at the same time a profuse watery scalding coryza. With these symptoms there is more or less sore throat. These symp- toms recur at every fresh exposure. There is scarcely any drug which will cure these cases quicker than will Iodide of Potassium. There is another salt of potash that has an antidotal relation to Mercury, and that is Kali chloricum. This is just as efficient an anti- dote when the poison has developed a sort of scorbutus, and the gums are spongy, soft, and bleed easily; there are ulcers of an aphthous character in the mouth and throat, and foetor of the breath. Aurum has next mention. This we find particularly called for in the suicidal mania which may develop after a course of Mercury, and also for the caries of the bones, particularly of the bones of the palate, nose, etc Asafcetida also comes in as a drug to be thought of in the bone affections developed by Mercury. Here you have, as a characteristic distinguishing it from the others, extreme sensitiveness around the dis- THE PREPARATIONS OF MERCURY. 557 eased portion of bone. For instance, in the case of an ulcer communi- cating with a carious tibia, the parts are so sensitive that the patient can scarcely bear the dressing that you apply. You will find that the tissues are firmly adherent to the bone for some little distance around the inflamed portion Then, too, you find Asafcetida sometimes indi- cated for iritis following mercurialization. Here, to distinguish it from other remedies, you have the same characteristic, extreme soreness of the bones around the eye. Staphisagria is an antidote for Mercury, and in rather bad cases, too, when the system is very much depreciated by the mercurial poison. We find the patient wasting away and sallow, dark rings around the eyes, well-marked mercurial mouth and throat, with spongy gums, tongue flabby, ulcers on the tongue and in the throat and well-marked bone pains. Lachesis is an occasional antidote for some of the symptoms, but there are no special characteristics. Iodine comes in as an antidote when the glands are affected. Mezereurn is an excellent antidote when the mercurial poisoning has invaded the nervous system and neuralgia has developed. This neuralgia may appear in the face, in the eyes or in any part of the body. Lastly, we have Stillingia. Mercury, it is well known, enters into loose combination with the tissues of the body. It has been found in every tissue and may be excreted by almost every channel. It has been found in the perspira- tion, urine, bile, faeces and saliva. It has even been found in the child in utero and, again, in the nursing infant, when the drug has been taken by the mother. I said that the combination of Mercury with the tissues is a loose one, by which I mean it is easily displaced. If a person is poisoned with Mercury, it will be readily displaced by one of the above remedies. It is only the chronic cases that need alarm you, and the cure of which, you may despair of. When mercurializa- tion is combined with other poisons, as with syphilis and scrofula, then you will have greater difficulty. The symptoms of poisoning by Mercury may be stated as these: After exposure to the poison, the patient has a rather disagreeable odor to the breath; that is, a sickening sort of odor hard to describe but easy to remember. There is also a sort of metallic taste complained of. These are very early symptoms and assert themselves long before the well- known characteristics of the drug appear. The patient feels languid and is frequently sick at his stomach. He vomits his food without any 558 A CLINICAL MATERIA MEDICA. apparent cause. His face becomes rather pale, with dark rings around the eyes; the lips are rather livid and purplish. He complains of heat, particularly in the forehead and down the root of the nose. He cannot bear the warmth of the bed. As soon as he gets warm in bed, his aches and pains return. Then his mouth begins to feel sore. The mucous membrane becomes puffed, swollen and redder than natural. The sali- vary glands begin to secrete more rapidly and the mouth is filled with saliva, which is, however, normal in its composition. In a more ad- vanced case, the saliva becomes vitiated. It is no longer the pure secretion, for the glands are overworked. The breath becomes more and more offensive, the gums swell and are tender to touch and the teeth become loose. A dark red line sometimes appears on the gums below the teeth. Later, the gums grow spongy and yellowish-white and ulcerate and discharge an offensive matter. The tongue swells and readily takes the imprint of the teeth. The glands then become in- volved and you find more or less tumefaction of the parotid and cer- vical glands. If you were to look into the mouth at this stage, you would find the opening of Steno's duct red and inflamed and, in some cases, even ulcerated. Other glands, too, are affected. We find the pan- creas attacked by Mercury. The liver also comes in for a share of the poison. You are probably aware that the liver has been said to be affected by Mercury, and that allopathic physicians have been accus- tomed to give blue mass or calomel in almost every attack of '' liver- complaint." Quite recently, several eminent physicians in the old school have declared that Mercury does not increase the flow of bile and hence is not useful for torpid liver; but, however that may be, it is certain that Mercury does affect the liver in one way or another. It has caused catarrh of the duodenum, and this catarrh has extended along the bile-duct into the liver. This is a form of trouble which frequently causes jaundice, and a form, too, for which Mercury is useful. It has also produced and cured hepatitis, particularly when one or more abscesses have formed in the liver. Individual suscepti- bility varies these symptoms considerably. You will find that it is more difficult to salivate children than adults. Some persons are salivated by very small quantities, while it is difficult to affect others. The scrofulous are very seriously affected by Mercury, as you all know7. The more remote symptoms of mercurial poisoning are these: You will find that the blood becomes impoverished. The albumin and fibrin of that fluid are affected. They are diminished, and you find in their THE PREPARATIONS OF MERCURY. 559 place, a certain fatty substance; the composition of which I do not ex- actly know. Consequently, as a prominent symptom, the body wastes and emaciates. The patient suffers from fever which is rather hectic in its character. The periosteum becomes affected and you then have a characteristic group of mercurial pains, bone pains worse in changes of the weather, worse in the warmth of the bed, and chilliness with or after stool. The skin becomes rather of a brownish hue; ulcers form, par- ticularly on the legs; they are stubborn and will not heal. The patient is troubled with sleeplessness and ebullitions of blood at night; he is hot and cannot sleep; he is thrown quickly into a perspiration, which per- spiration gives him no relief. The entire system suffers also, and you have here two series of symptoms. At first, the patient becomes anxious and restless and cannot remain quiet; he changes his position; he moves about from place to place; he seems to have a great deal of anxiety about the heart, praecordial anguish, as it is termed, particularly at night. Then, in another series of symptoms, there are jerkings of the limbs, making the patient appear as though he were attacked by St. Vitus's dance. Or, you may notice what is more common yet, trembling of the hands, this tremor being altogether beyond the control of the patient and gradually spreading over the entire body, giving you a re- semblance to paralysis agitans or shaking palsy. Finally, the patient becomes paralyzed, cannot move his limbs, his mind becomes lost, and he presents a perfect picture of imbecility. He does all sorts of queer things. He sits in the corner with an idiotic smile on his face, playing with straws; he is forgetful, he cannot remember even the most ordinary events. He becomes disgustingly filthy and eats his own excrement. In fact, he is a perfect idiot. Be careful how you give Mercury; it is a treacherous medicine. It seems often indicated. You give it and relieve; but your patient is worse again in a few weeks and then you give it again with relief. By and by, it fails you. Now, if I want to make a permanent cure, for instance, in a scrofulous child, I will very seldom give him Mercury; should I do so, it will be at least only as an intercurrent remedy. I have placed on the board in tabular form, a list of the mercurial salts together with the parts of the body on which they act. Wherever you notice the cross, you know that the preparation acts on the part of the body placed on that line under the heading of Mercurius vivus. This table is only a convenient form. There is nothing practical or scientific in it. 560 A CLINICAL MATERIA MEDICA. Mercurius Vivus. Eyes .... Nose..... Mouth and Throat, Kidneys and "1 Bladder, / Heart...... Lungs ...... Genitals..... Glands and \ Bones, j Skin....... Stomach and ) Liver, j* Bin. Prot. Cyan. Dulc. Corros. Cinn. Sulph. Rub. Acet. — + — + + + — — — + + + — + + — — — ■+ + + + + + — — — — + — + — — — + — + + — + — + + — + + — — + + + — — + + + — • + + — + — + + + + + + + + + + + + — + + — + — -h + — — + + + — — Taking Mercurius vivus as a type of the whole, as an individual remedy in fact, we find that it is indicated in persons who are of a scrofulous habit, whether of syphilitic constitution or not, in whom the glandular system is active. This glandular activity shows itself in two ways. In the first place, we may have a condition simulating plethora. In more advanced stages, we may find Mercurius indicated in enlarged glands with emaciation and deficiency of blood. We find Mercurius, too, indicated in scrofulous children who have unusually large heads with open fontanelles, particularly anterior fontanelles. They are slow in learning to walk, the teeth form imperfectly or slowly, the limbs are apt to be cold and damp, and there is a damp, clammy feel- ing to the limbs. You may distinguish it from Calcarea, Silicea and Sulphur by these characteristics: The head is inclined to perspire in the Mercurius case, but the perspiration is offensive and oily. It is not as often indicated as Calcarea, Silicea or Sulphur, nor is it as certain or as permanent in its effects. But it may come in as a remedy to par- tially relieve, and it may be indicated as an intercurrent remedy in a course of treatment with Sulphur, when the latter remedy seems to fail. You will find the Mercurius patient illustrating plethora with anxiety and restlessness, tossing about, moving from place to place. It is one of the remedies useful for nostalgia or home-sickness. The patient becomes anxious and irritable. This anxiety seems as if it THE PREPARATIONS OF MERCURY. 561 were in the blood, that is, it is always attended with ebullitions of blood. That distinguishes it from other remedies. The congestions of Mercurius indicate it after Belladonna. There are resemblances between the two remedies, which have been well con- firmed clinically. It often follows Belladonna in inflammations, even in inflammation of the meninges of the brain when, as under Bella- donna, there are the same hasty speech and the quick, nervous talking; the child talks so rapidly that one word runs into another. Its man- ner is just as quick and nervous as its speech. You will find the face flushed very much as in Belladonna, but you have, in addition, to dis- tinguish it from that remedy, glandular swellings, and tendency to sore mouth. You find Mercurius often indicated in catarrhal or gastric fevers when the face is puffed, when the throat is swollen, both internally and ex- ternally, from involvement of both glands and cellular tissue; when there are aching pains in the joints, which are rendered worse by the warmth of the bed, and are not relieved by sweat. In addition to this you almost always find that there is a tendency to catarrh of the bowels. This is characterized by slimy, bloody stool, accompanied by great tenesmus, this tenesmus not ceasing after stool. Here, too, you find Mercurius to follow Belladonna. We find Mercurius indicated in haemorrhages. It is often called for in nose-bleed or epistaxis, particularly when the blood coagulates and hangs from the nostrils like icicles. This is a useful hint. Sup- pose that in a full-blooded patient, a boy at the age of fifteen or six- teen, when congestions are so frequently noticed, or that in a scrofulous child, nose-bleed appears. You have given Belladonna, Hamamelis, and Erigeron, and have failed to check it. The blood is quite bright, and runs in streams. Medicines do not stop it. Then comes this Mercurius condition. You give that remedy and cure, not only that attack, but you prevent the return of others. The same indications apply to uterine haemorrhage or menorrhagia when the flow is profuse, dark and clotted. Then, if the other symptoms agree, glandular swell- ing, sore mouth, etc., Mercurius is certain to be the remedy. We find Mercurius often indicated in pneumonia. Here it requires that the right lung be affected, and that there are also icteroid symp- toms. The skin is yellow. There is sharp stitching pain through the lower portion of the right lung. There will be other symptoms pecu- liar to pneumonia present, but these need not be specified separately. We find it indicated in peritonitis, and here it follows Belladonna 36 562 A CLINICAL MATERIA MEDICA. when suppuration has commenced and you have tympanitic abdomen, some evidence of effusion, which will be partly serous and partly pur- ulent, sweat, rigors, etc. Here Mercurius comes in and prevents the further spread of the suppurative process. Another condition in which we may use Mercurius is one of inflam- mation in which suppuration has occurred, whether the disease be a boil, a tonsillitis, or any other form of inflammation. We here find Mercurius connected with an interesting little group of medicines which you will use very often; they are Belladonna, Hepar, Mercurius and Lachesis. To these we may also add Silicea and Sulphur. We prefer Belladonna in the beginning of inflammation as in tonsillitis. The throat is bright red and swollen, and there is difficulty in swallowing fluids, and sharp pains through the tonsils. You should change to Hepar when the sharp sticking pains and chills indicate the beginning of suppuration. It may prevent suppuration when given in the incipiency of that process. Mercurius is suited to a still more advanced state w7hen pus has formed and you wish it evacuated. If you give it too soon you will spoil the case. Mercurius does not prevent the formation of pus, but rather favors it. In felons, if it is given low, it will generally favor the rapid formation of pus. Silicea follows Hepar better than does Mercury when pus continues to discharge and the wound refuses to heal. In some of these cases, the benefit under Silicea will cease. Then a dose or two of Sulphur will excite reaction and the Silicea can effect a cure. Lachesis is indicated when the pus degenerates and becomes of a dark, thin, offensive character. Mercurius vivus we find indicated in inflammations in and about the eyes, usually of scrofulous or syphilitic origin. We find that the patient suffers from the glare and heat of the fire, consequently he avoids the fire and warm rooms. You sometimes find it indicated in blepharitis of men who work in and about fires, as foundrymen. The pains are usually worse at night. The lids are thickened, especially at their tar- sal edges, and the eyes discharge a thin acrid muco-pus. This makes the cheeks sore, and you find little pimples scattered over the cheeks. Ulcers may form on the cornea. These ulcers are usually superficial, and have an opaque look as though pus were between the corneal layers. In syphilitic iritis Mercurius solubilis will be sometimes in- dicated when there is hypopyon. Now let us distinguish between this ' and other preparations of Mercury. THE PREPARATIONS OF MERCURY. 563 The Biniodide of Mercury is indicated in inflammations of the eye. The symptoms are very similar to those of '' vivus,'' but there is more glandular swelling under the Biniodide. The Protoiodide is more frequently indicated in eye diseases than is the Biniodide. It is called for in corneal ulcers which look as if they had been chipped out with the finger nail. There is usually, when it is the remedy, a thick yellow coating on the base of the tongue, the anterior portion being clean and red. Mercurius dulcis, or calomel, is selected more by its general symp- toms, which are these: It is indicated in scrofulous children who are pale, and who have swelling of the cervical and other glands. The skin is rather flabby and ill nourished. The flabby bloatedness and pallor are the indications for calomel. Next to this we have Bichloride of Mercury or Mercurius corrosivus. This is indicated in inflammatory symptoms of the most violent char- acter. There is no mercurial that produces such intense symptoms as does the Bichloride. It produces burning, agonizing pains, with most excessive photophobia and profuse excoriating lachrymation, making the cheeks sore, almost taking the skin off so excoriating is it. There are tearing pains in the bones around the eye. There is ulceration of the cornea, with tendency to perforation. In such cases you will, as a matter of course, have hypopyon. Mercurius corrosivus is almost a specific for syphilitic iritis. If the symptoms of the case do not point to some other drug as the remedy, you should give it in this disease. If you choose to use atropia locally, do so in order to prevent the adhesions which will otherwise almost inevitably take place in these cases. You will also find Mercurius corrosivus indicated in retinitis albuminurica. Cinnabaris is next. That is a remedy for a variety of inflamma- tions of the eye. I will only give you one symptom for it, and that is pain which shoots across the eye from canthus to canthus, or seems to to go around the eye. Next, the action of Mercury on the nose. We find Mercurius vivus indicated in catarrhs of the nose and throat, which are provoked by damp, chilly weather, and by the damp, cool evening air. The nose itches and burns and feels stuffed-up; with this there is thin coryza. The throat feels raw and sore. There is aching in the various joints. These are the symptoms which will indicate Mercurius both as to their exciting cause and as to the symptoms present. You may have with these a hot feeling. The face flushes up and gets red, perspiration 564 A CLINICAL MATERIA MEDICA. breaks out but it gives no relief. There is another form of coryza in which you may give Mercurius, and that is when the cold is " ripe," when the discharge from the nose is yellowish-green, thick and muco- purulent. Here it rivals Pulsatilla, which is also useful for these thick, yel- lowish-green nasal discharges. Pulsatilla, independently of its other symptoms, is distinguished by the fact that the discharge is never irritating, but is perfectly bland. You are also to distinguish Mercurius from Nux vomica, which is suited to coryza caused by exposure to dry cold, and when there are soreness, roughness and a harsh, scraped feeling in the throat. Mer- curius always has a smarting, raw or sore feeling. Now, the throat symptoms of Mercurius vivus may lead you at times to think of it in diphtheria. Think of it as much as you choose, but think of it only to reject it. It is not indicated in diphtheria. I do not believe it indicated even in diphtheritis. But there are prepara- tions which may be used here. We first notice the Mercurius bin- iodatus. Both the Biniodide and the Protoidide of Mercury are indi- cated in diphtheritic sore throat, or even in true diphtheria. The Biniodide is of use when the membrane is on the left side, when the left tonsil is inflamed and there is a yellowish-gray membrane forming there. The glands of the neck are swollen. There is also some in- volvement of the cellular tissue around the throat. The patient may have an accumulation of slimy or sticky mucus, in the mouth and throat. The symptoms are worse from empty swallowing. The simple attempt to swallow saliva excites more pain than does the swal- lowing of food. The Protoiodide of Mercury is more to be thought of when the deposit begins on the right side of the throat, with swelling of the glands in the neck and with the accumulation of this tenacious mucus in the throat. Here there is almost always present that thick, yellow, dirty coating on the base and posterior part of the tongue, the tip and sides of that organ being red. These twro remedies are often indicated in diphtheria and diphtheritic sore throat. Next you will notice the Cyanide of Mercury, wdvich is a combina- tion of hydrocyanic acid and mercury. We have in this drug one of the very best remedies in diphtheria, especially when it is of a true adynamic or malignant type. By reason of the presence of the prussic acid you will find it indicated in cases in which the patient is very much prostrated from the beginning. The pulse is quick. It may be THE PREPARATIONS OF MERCURY. 565 as high as 130 or 140, and it has no volume to it at all. The membrane at first is white, covering the velum palati and tonsils. The glands soon begin to swell, however, and then the membrane becomes dark, threatening even to grow gangrenous, Weakness is extreme. The breath is foetid. There is loss of appetite. The tongue is coated brown, or, in severe cases, even black. Nose-bleed sets in, and this you know is a dangerous symptom. It may also be used in diphtheria of the larynx. The expectoration is thick and ropy. There is harsh, bark- ing, croupy cough, with dyspnoea. Here, too, the Cyanide of Mercury has saved life, but it will not always do so. You will notice its resemblance to Kali bichromicum in diphtheritic croup. The resemblance lies in the position of the disease, that is, in the larynx and in the thick, tough, tenacious expectoration. The dis- tinction lies in this: The Cyanide of Mercury has great weakness. Now this weakness is not a simple prostration which should come from the efforts of the child at breathing. It is due to poisoning of the blood, which is represented by the blueness of the surface, coldness of the extremities, and quick, weak pulse. If you have not these, Kali bichromicum is to be preferred. Cinnabaris is a remedy not often thought of in catarrhal troubles. It is indicated in nasal catarrh when there is great pressure at the root of the nose, a feeling as though something weighty was pressing on the nose, a heavy pair of spectacles for instance. We also frequently find throat symptoms with this form of catarrh. The throat is swollen and the tonsils are enlarged and redder than normal. There is great dry- ness in the throat, and this is more annoying at night, waking the patient from sleep. Remember this sensation across the bridge of the nose and the character of the throat symptoms in connection with it. These symptoms may occur in the syphilitic, in the scrofulous, or in persons jn whom there is tendency to catarrh. We.have found Ciima- baris of use in the sore throat of scarlatina, which is often diphtheritic in its character, when there is quite an accumulation of stringy mucus in the posterior nares. That symptom being prominent, Cinnabaris will be the remedy for the emergency. I have used Mercurius corrosivus successfully when the accumulation of mucus in the nose is quite thick; in fact, almost like glue. In some cases of syphilitic disease of the nose, you find Mercurius corrosivus in- dicated from the fact that the ulcers perforate the septum of the nose. In these cases there are burning pains, the discharges are acrid, corrod- ing the tissues over which they flow. 566 A CLINICAL MATERIA MEDICA. The throat symptoms of Mercurius corrosivus are very violent. I can conceive of cases where it would be required in diphtheria, and yet I have never given it in that disease. The uvula is swollen, elongated and very dark red. There is intense burning in the throat, just as in- tense in fact as that of Arsenicum albtim, Arsenicum iodatum or Cap- sicum. This burning pain is rendered intolerable by any external pressure. It is accompanied by violent constriction of the throat. Any attempt to swallow, be the matters swallowed solid or liquid, causes violent spasm of the throat, with the immediate ejection of the solid or liquid. You here recognize a resemblance to Belladonna in the spasmodic character of the symptoms. Mercurius corrosivus is at once distin- guished from Belladonna by the inflammatory tendency of the symp- toms as indicated by these extreme burning pains. Thus it has the constrictive quality of the Belladonna plus the most intense, destruc- tive inflammation of the throat. You may further distinguish be- tween the two remedies by the pulse. In Mercurius corrosivus the pulse is quick, weak, and irregular, and not full and strong as under Belladonna. Next, a word or two about the Mercuries in their action on the genitals and the glands. The Mercuries have long been used in the treatment of syphilis. Mercurius solubilis or vivus is indicated in primary syphilis for the so-called soft chancre or chancroid. The ulceration is superficial rather than deep, and the base of the sore has a dirty, lardaceous appearance. Mercurius sol. has produced such an ulcer as this, and, therefore, it ought to cure it. The sore throat which often ushers in the syphilitic fever six or seven weeks after the appearance of the primary lesion, is also found under Mercurius solubilis The Iodides of Mercury are the preferable remedies for the Hunterian or hard chancre. That is a form of ulcer which the Protoiodide and Biniodide have both produced, therefore they will cure it. There is no necessity whatever for such external applications as caustics, for the proper internal remedy if it does not entirely prevent the onset of second- ary symptoms will at least lessen their intensity. Mercurius corrosivus is to be preferred to any of the drugs mentioned for syphilitic symptoms when the ulceration is very destructive. The ulcer is serpiginous; it has a ragged edge, eating out and destroying in a few days nearly half the penis. Secondary syphilis may be treated with one or the other of these preparations, if the drug has not been abused in the primary stages THE PREPARATIONS OF MERCURY. 567 Mercurius solubilis very quickly helps those syphiloderms on the palms of the hands. They are red, itch slightly, and scale off. Returning to Mercurius vivus, I want to say a few words concern- ing its use in diseases of the liver. The tongue is coated a dirty yel- lowish-white and takes the imprint of the teeth. There are scorbutic symptoms frequently present. The gums ulcerate and become spongy. There is a foetid or disagreeable odor from the mouth. The skin and conjunctiva have a well-marked jaundiced or icteroid hue. There is tendency to rush of blood to the head. The region of the liver is sore to the touch. The abdomen is rather tympanitic and swollen, particularly across the epigastrium and in either hypochondrium. The patient cannot lie on the right side. You wall find the liver enlarged and often indurated. The stools are either clay colored, from absence of bile, or there are yellowish-green bilious stools, passed with a great deal of tenesmus and followed by a " never-get-done feeling. Mercury is indicated in dysentery, especially when it occurs in a season when warm days are followed by cold nights. Nux vomica has many resemblances to Mercurius, but it differs in that the pains and tenesmus usually cease after stool; whereas, with Mercurius, they continue after stool. Aconite often precedes the exhibition of Mercury in the weather I have spoken of, hot days followed by cold-nights. In the incipient stages, such troubles may be checked by Aconite. If Aconite fails, then Mercurius will be indicated. Often, after the tenesmus and blood have ceased, and the mucus still persists, Sulphur will be the remedy. There is another remedy to be remembered in connection with Mer- cury in bilious troubles, and that is Leptandra. Both of them have these yellowish-green stools, and stools black like pitch, and horribly offensive stools. The distinction lies here: Leptandra has urging to stool, griping continuing after stool, but not the tenesmus. Leptandra frequently has dull, aching, burning pains in the posterior portion of the liver. LECTURE LVI. THE NOBLE METALS—AURUM. In this group we have Aurum metallicum, Aurum muriaticum, Ar- gentum metallicum, Argentum nitricum, Platinum and Palladium. There are also two or three others of which we know but little. Aurum and Argentum have many symptoms in common, and yet their distinctive characteristics are sufficient to enable you to separate them readily in practice. I will give you the general distinctions between the two drugs before I consider them individually. Gold affects more the circulation of the blood. It also acts on the mind, producing emotional symptoms. Now, by this I mean that if you find symptoms of the nervous system in Aurum, they will be followed by symptoms of the circulation as the primary or most important quality. Argentum has more symptoms of the respiratory organs and intellec- tual part of the mind. With Aurum, we have tendency to hyperaemia; in Argentum, more nervous phenomena; only, Aurum seems to attack the bones. We find very few symptoms of Argentum indicating it in bone affections The latter, however, causes an arthralgia or neuralgic pains in the joints. It also attacks the cartilages of joints. For in- stance, you find Argentum metallicum useful in the arthralgic pains of women who suffer from prolapsus uteri. They can scarcely move their joints, and yet a most careful investigation shows no rheumatic inflammation. Aurum suits in scrofula with redness of the face, thus keeping up the tendency to hyperaemia or fulness of the bloodvessels. In these scrofulous cases, you will find that the opacities and ulcers on the cor- nea are surrounded by well-filled bloodvessels; here, again, the hyper- semic quality of the drug is well brought out. Argentum suits in chlorosis. It affects the oxidizing power of the blood; it shrivels the body. Aurum affects the distribution of the blood, giving us fulness or hyperaemia, whereas Argentum affects its quality, rendering it incapable of fully carrying oxygen. Hence, all parts of the body become dwindled from malnutrition. Silver, and especially its nitrate, coagulates albumen, and this is the reason why the latter has been used locally for so many years as a caustic. When applied with moisture to animal tissues, it imme- AURUM. 569 diately coagulates the albuminous portions, and so tends to destroy whatever process is going on. Its action does not extend deeply, however, on account of the formation of this layer of coagulated albumen. Argentum nitricum more than the metal itself, causes gastro-enteric inflammation, very much like Arsenic. In poisoning cases it also seems to affect the epithelial layers. For instance, when animals that have been fed on it for quite a while die, the epithelial layers in all parts of the body seem to be more or less destroyed. That is the rea- son why you find it of use in cancer and in haemorrhages, in both of which conditions the epithelial structures are diseased. Aurum Metallicum. Aurum met. < 1. Mind. 2. Hyperaemia. 3. Induration. 4. Bones. 5. Fatty degeneration. Aurum met. - Belladonna. Mercurius, Nitric acid. Arsenic, Asafcetida. Ammonium carb. Natrum mur. > Hepar. >Bell. >Merc Aurum is a remedy of not very extensive application, but still it is well marked in its limited sphere. Its antidotes are principally He- par, Belladonna and Mercurius. I am not positive that there is a com- plement to Aurum. Now, in studying the action of this remedy, we are to keep in mind, first, this one prominent quality, its power of producing hyperaemia; and, secondly, its action on the emotional mind more than on the intellectual. First, let us study the hyperaemia of Aurum. We find this in every part of the body on which it may act. It affects the heart, causing increased activity of that viscus. This increased activity of the heart is indicated by increased force of the heart-stroke, just as you find in pure cardiac hypertrophy without dilatation. As a result of this in- creased action, the heart enlarges, and you have, secondarily, hyper- 570 a clinical materia medica. trophy of the heart. Consecutive to this trouble, you have a list of symptoms that are very characteristic. The lungs are too full of blood, or hyperaemic The condition is exhibited in this manner: The patient on attempting to walk up hill, or use any little exertion, feels as though there were a crushing weight under the sternum. He feels that if he did not stop walking the blood would burst through the chest. Aurum relieves this kind of a case very nicely. According to Kafka, Aurum muriaticum is here preferable to the metallicum. It is here very similar to Ammonium carb., which has this crushing weight on the sternum; but this remedy has more tendency to somno- lence, and is better suited to venous fulness than is Aurum. This condition of the heart necessarily causes hyperaemia in other organs. We find, for instance, this tendency to rush of blood to the head aggravated by mental labor, because study always increases the amount of blood in the brain, if there is any tendency to cerebral con- gestion. There is a feeling of fulness in the head, accompanied by roaring in the ears. The head feels sore and bruised, and the mind is confused. Sparks or flashes of light before the eyes show pressure on the retinal vessels. The face, in extreme cases of congestion, is rather bloated, and has a glassy look. Still further evidence of the hyperaemia in the eye is displayed by the ophthalmoscope. You find a sensation in the eye as though it were being pushed out, with a certain amount of tension there. Two errors of vision may be associated with these symptoms; either he sees double, or he suffers from what is known as half-sight. Now, these symptoms are suggestive of hyperaemia of the brain, which may occur from various causes, among the most promi- nent being overwork with the eyes, and persistent use of the eyes, or working in hot places. Glaucoma may suggest Aurum. In scrofulous ophthalmia we frequently find Aurum indicated, if there are present those symptoms of congestion. The bloodvessels are very much injected; panuus is present; great vascularity is a characteristic in these cases calling for Aurum. In addition, you will find profuse scalding lachrymation. The eyes are very sensitive to the touch. Aurum may be used in cases of syphilitic iritis when the eye is de- cidedly worse from touch. There is a very characteristic soreness around the eye, as if in the bones. Especially is it indicated in syph- ilitic cases after the abuse of mercury. In retinal congestion, you should compare with Aurum, Belladonna, Glonoin and Sulphur. AURUM. 571 In syphilitic iritis, with that sore, bruised sensation around the eyes, compare Asafcetida. This remedy, however, has less of that sensitive- ness around the eyes. You may also compare here, Mercurius corro- sivus and Nitric acid. The nose, too, is congested and has a red, knobby tip, greatly disfig- uring the face. This may exist as a sequel to the long indulgence in alcohol, or it may be found in children as a symptom of scrofula. If the latter is the case, it is often accompanied by the characteristic catarrh for which Aurum is the remedy. In nasal catarrh or ozaena it is indicated when the nostrils are sore and cracked. There is foetid nasal discharge, often "accompanied by caries of the nasal bones. There is ulceration of the soft parts with perforation of the nasal septum. It is especially indicated in cases of scrofulous or mercurio-syphilitic origin. The Aurum symptoms of the ears are not very numerous but are sug- gestive. The ears are congested, and you find roaring in the ears, as I suggested a few7 moments ago. Further than this, you find great sen- sitiveness to noises. Now, it is sometimes indicated in catarrh of the middle ear. In these cases you note a foetid otorrhoea. In addition to this you will very likely find the membrana tympani seriously damaged. The external auditory meatus and the mastoid process of the temporal bone become affected by direct spread of the disease. There are boring pains in the mastoid process. The trouble may progress to caries. I have already shown you illustrations of the effect of Aurum on the bones. You noticed that it was indicated in iritis with pains in the bones around the orbits; and you know also that it affects the nasal bones, producing caries there. In this affection of the mastoid process Nitric acid is the nearest ally to the Aurum metallicum. For simple soreness or inflammation, beginning in the mastoid cells, Capsicum has won some laurels, but for caries of this process, Aurum, Silicea and Nitric acid are the best remedies. Aurum has some throat symptoms. The tonsils are apt to be red and swollen, and the parotid gland on the affected side feels sore, as if con- tused. The hard palate may be carious. With all this, there is a mer- curial or syphilitic history. I have dwelt on these symptoms because they are those which Aurum has most frequently removed. Returning to the circulatory disturbances of Aurum, we find a hyper- aemia of the kidneys. This is shown in the beginning by simple increase in the amount of urine passed. By and by the kidneys begin to undergo 572 A CLINICAL MATERIA MEDICA. fatty degeneration. The urine then grows scanty and albuminous, or there may be granular or cirrhosed kidney. Aurum will not do any good in these cases, unless the renal trouble is secondary to some heart affection. The nearest remedy, pathologically, to Aurum in granular kidney is Plumbu77i. We find, too, that the genital organs are affected by this hyperaemia and there is strong tendency to erections. The testicles become inflamed, particularly the right. Aurum is especially suited to chronic orchitis, particularly when the right testicle is affected. As another sequel to this effect of Aurum, we find hepatic congestion. The liver is swollen consecutive to cardiac disease. This hyperaemia is associated with burning and cutting in the right hypochondrium. As the hyperaemia continues, the liver becomes cirrhosed or else undergoes fatty degeneration. Ascites appears. The stools are of a grayish or ashy- white color from defective amount of bile, and we have here, as in almost all ailments in which Aurum is the remedy, a peculiar state of the emotional mind, a melancholy or a low-spiritedness, which I shall describe to you presently. The lungs are also hyperaemic There is great oppression of the chest, which is worse at night, particularly in the first part of the night; it is worse from prolonged exercise, from prolonged walking. The face.may be purple. In extreme cases, syncope may take place. On the female organs we find Aurum acting powerfully, causing con- gestion of the uterus. The uterus becomes prolapsed from its great weight. It is enlarged from chronic congestion. This is the form of prolapsus which Aurum will cure, and no other. The ordinary rem- edies for prolapsus, such as Lilium or Nux vomica, cannot relieve this case, because the prolapsus is not the main characteristic. The cause of the prolapsus is the weight of the organ and not the relaxation of the ligaments or weakness of the general system. There is another salt of gold which has been successfully substituted for Aurum 77ietallicum in these cases, and that is Aurum muriaticum natronatum. This has been used in the second and third potencies for prolapsed and indurated uterus. Aurum has some very characteristic mental symptoms. In almost all cases in which it is the similimum, there is present a melancholy, with disposition to weep, or with a feeling of self-condemnation, as if he was not fit to live. This feeling of self-condemnation or worthlessness may amount to despair, sometimes even taking the form of religious mania. AURUM. 573 He prays all the time. He is sure that he is going to be condemned. He has suicidal thoughts, if he does not make actual attempts at suicide. With all this there is a great deal of mental anguish, which mental anguish is associated with praecordial distress, by which I mean dis- tressed feeling referred to the cardiac region. In addition to the melan- choly, Aurum also produces weakness of the' memory. Decided anger may also be characteristic of the remedy. Any contradiction or dispute excites the patient furiously. He becomes red in the face and his pugnacity is aroused. Mental labor becomes irksome to the patient. He is very apt to suffer from headaches which are of a congestive char- acter, as has already been described. Next, we have to study the action of Aurum on the bones. This I will dismiss in a very few words. It is useful in caries of the cranial bones, and of the bones about the nose and palate, particularly after the abuse of mercury, whether the case be syphilitic or not. LECTURE LVII. THE PREPARATIONS OF SILVER. Argentum Nitricum. (/Arsenicum, Nitric acid. Argentum nitr. 1 Plumbum, Cuprum. ( Zinc. >• Natrum mur. Argentum nitricum, or the Nitrate of Silver, in its action on the brain and spine furnishes us with a list of symptoms that lead to the use of the remedy in many forms of nervous disease, from simple ner- vous debility to full-fledged locomotor ataxia, or paralysis. Among the anomalous sensations which it causes are the following, which are characteristic of the drug: A very common general symptom which may be present in the headache, ovarian affections and in many other diseases, is this, a feeling as if the body or some part of the body were expanding. In the case of headache, the patient has a sensation as if the head were enormously large. Sometimes, with the ovarian pains, the patient says that she feels as if there were an immense swelling in the side affected; and yet an examination shows no enlargement of the painful organ. We find this symptom under several other drugs, very prominently under Argentum nitricum, however. Again, vertigo is almost always present when it is the remedy. This vertigo is asso- ciated with general debility and trembling from nervous weakness. The patient staggers and reels as if he were intoxicated. The vertigo is so severe at times that he becomes momentarily blind in association with mental confusion, buzzing in the ears, nausea and trembling. The patient suffers from mental anxiety. He is very impulsive. He must be always busy and yet he accomplishes nothing. He makes frequent errors of perception. He hurries restlessly about to fulfill an engagement, thinking that he will be too late, when, in reality, he has an hour or so more than is necessary. In some cases, there is pro- found melancholy. He imagines if left alone he will die; full of appre- hension that he has some incurable disease of the brain. He constantly makes mistakes as to his estimation of distances. For instance, when walking the street, he dreads to pass a street corner, because the corner ARGENTUM NITRICUM. 575 of the house seems to project and he is afraid that he will run against it. All these errors are traceable to imperfect coordination of muscle. This last is no imaginary symptom; it has been met with a number of times and it has been cured by the Argentum nitricum. This defective coordination of muscles is a prominent symptom in the disease known as locomotor ataxia, for the treatment of which allo- paths have long employed Argentum nitricum as a most valuable remedy. We also may use it when the following symptoms are present: The patient staggers in the dark or when his eyes are closed. The legs are weak and the calves feel bruised as after a long journey. There is a feeling of soreness in the lumbo-sacral region; also pain in the small of the back, very severe when rising from a sitting posture, but rather relieved by walking. Zincum is also better from walking and worse from sitting. The difference between the two remedies is that Argentum nitricum has pain when rising. Sometimes there is pain in the sacro- iliac symphyses, a feeling as if the bones were loose there. Here it is similar to sEsculus hippocastanum. Another symptom which I would like to specialize is trembling of the hands, which causes the patient to drop things. He is very nervous at night. When he does sleep, he has all sorts of horrible dreams. These nervous symptoms are especially worse at eleven a. m. So you see that Sulphur is not the only remedy that has this eleven A. M. aggravation. You will at once see the resemblances between Argentum nitricum and Kali bromatum and Natrum mur. That trembling weakness, with palpitation, is the exact counterpart of the Natrum mur. condition. This fearful and apprehensive mood, this imagining that he cannot pass a certain point, reminds you of Kali bromatum. But there are less severe symptoms that will call for Argentum nit- ricum, and one of them is what we may call functional paralysis, such as follows exhausting diseases, post-diphtheritic paralysis, for example. Gelsemium is here a concordant remedy of Argentum nitricum. Other nervous affections, for which we may use Argentum nitricum, are the following: It is one of the best remedies we have for hemi- crania. This is not a simple neuralgia. It is a deep-seated neurotic disease, and by some is supposed to be of epileptic nature. It comes periodically; for its relief the remedy under consideration is one of the best. There is frequently boring pain in the head, wmich is worse in the left frontal eminence. This boring is relieved by tight bandag- ing of the head, hence the wearing of a tight-fitting silk hat relieves. It is excited by any mental emotion of an unpleasant kind, or by any- 576 A CLINICAL MATERIA MEDICA. thing that depreciates the nervous system, as loss of fluids, loss of sleep or mental strain. Sometimes the pains become so severe that the patient loses his senses. The paroxysms frequently culminate in vomiting of bile or sour fluid. There is another form of headache which is mostly neuralgic, and for which Argentum nitricum is the remedy. The bones of the head feel as if they were separating, or the head feels as if it were enormously large. The pains about the head increase to such a degree that the patient almost loses her senses. These attacks end in vomiting, prob- ably to recur once more within a few minutes or an hour. We also find Argentum nitricum indicated in prosopalgia, particu- larly when the infraorbital branches of the fifth pair and the nerves going to the teeth are affected. The pain is very intense and at its height is accompanied by unpleasant sour taste in the mouth. The pains are of the same character as those already described for the hemi- crania. I do not believe that this sour taste in the mouth is of gastric origin, but I think that it is due to some abnormality or disturbance in the gustatory nerves. The face, in almost all these cases, is pale and sunken, rather sallow than pure pale, and in extreme cases, w7hen the blood is very much affected, the surface of the body is of a dark, muddy, leaden hue. We also find Argentum nitricum indicated in that troublesome dis- ease, gastralgia, a neurosis of the stomach. It is especially indicated in delicate nervous women. The gastralgia is excited by any emotion, by loss of'sleep, and frequently at the catamenial period. There is a feel- ing in the stomach as though there was a lump there. This is some- times accompanied by7 gnawing ulcerative pain referred to the pit of the stomach. From this spot, pains radiate in every direction. These pains seem to increase and decrease gradually, just as under Stannum. With this there is apt to be intense spasm of the muscles of the chest. The patient cannot bear to have a handkerchief approach the mouth, as it would cause dyspnoea. The patient cannot bear the least food because it makes this pain worse. Sometimes the pain is relieved by bending double and pressing the hand firmly into the stomach. The paroxysms end with vomiting of glairy mucus which can be drawn into strings, or what is more common, they are accompanied with enor- mous accumulation of wind. The patient for a long time cannot belch, but when he does succeed in so doing, the flatus comes in an enormous volume. This is often accompanied with general tremor, and a ner- vous feeling, or by a sensation as if the head was being squeezed in a vise. ARGENTUM NITRICUM. 577 The nearest ally to Argentum nitricum here, is Bismuth, which is indicated in pure nervous gastralgia. The main distinction between it and Argentum nitricum is in the vomiting. Just as soon as food touches the stomach it is ejected. Another nervous disease in which Argentum nitricum is indicated is epilepsy. The strong indicating symptom for Silver nitrate is this: For days or hours before an attack the pupils are dilated. After the attack, the patient is very restless and has trembling of the hands. It is especially indicated in epilepsy caused by fright or in that which comes on during menstruation. It may also be used for puerperal convulsions, when between the attacks, the patient is very restless, and tossing about, now on one side and now on the other. Nitrate of Silver is also indicated in angina pectoris. The patient complains of intense pain in the chest and about the heart. He can hardly breathe. We also find it indicated in pure nervous asthma. There are present spasms of the respiratory muscles. The dyspnoea is great. A crowded room produces or aggravates this dyspnoea. Leaving now the action of Argentum nitricum on the nervous sys- tem, we come to its use in inflammations and ulcerations. First of all, under this head, we will consider it in diseases of the eye. Nitrate of Silver cures purulent ophthalmia, and by this term I mean any inflam- mation of the lids or eyes which develops ulceration or pus. This pus is thick, yellowish and bland. It is useful in ophthalmia neonatorum when the pus is of the character just mentioned and is profuse. Es- pecially is it called for after the failure of Pulsatilla or one of the mer- curies. You may also use it for the purulent ophthalmia of adults with pus of this character. Like Pulsatilla, the symptoms are relieved in the open air and become intolerable in the warm room. In purulent ophthalmia, Pulsatilla stands very closely allied to Ar- gentum nitricum. You will notice that both have profuse, thick, bland, purulent discharge, and both have relief from the cool open air. It has been determined clinically that when Argentum nitricum ceases to act, a dose of Pulsatilla interpolated, helps. You may also use Argentum nitricum in blepharitis when there are thick crusts on the lids, suppuration and induration of tissue. Even the cornea has become affected by the continued inflammation. The 37 578 A CLINICAL MATERIA MEDICA. heat of the fire makes the patient a great deal worse. This symptom you also find under Mercurius. Granular conjunctivitis also calls for Argentum nitricum. The conjunctiva is almost scarlet, so red is it, and there is profuse muco- purulent discharge. Rhus tox. is very similar to Argentum nitricum, but it has more spasmodic symptoms. There is spasmodic closure of the eyelids, and when you force them open, hot, scalding tears gush forth, and these cause pimples around the inflamed eyes. Euphrasia is similar in granular lids; it differs from Argentum nitricum in this: The purulent discharge is excoriating, and there is, in addition, excoriating lachrymation. Kreosote may be used in inflammation of the eyelids, whether in the infant or the adult. There is a discharge of hot, scalding tears from the eyes, occurring early in the morning. Argentum nitricum may be useful in asthenopia from want of ac- commodation. Even the coarsest kind of work strains the eyes. Coming now to the mucous membrane of the mouth and throat, we find Argentum nitricum producing a dark red appearance of the fauces. Thick mucus collects in the throat and the patient complains of a sen- sation as of a splinter there. With all this, there may be ulceration. The cause may be mercury, syphilis or scrofula. The papillae of the tongue are elevated. The gums are tender and bleed readily, but are very seldom swollen, thus giving you a distinction between it and Mercurius. The larynx suffers from the action of Argentum nitricum. There is muco-purulent sputum, seeming to come from the posterior wall of the larynx. There is also marked hoarseness and sometimes even loss of voice. Singers frequently complain of a feeling as if there were some- thing clogging the vocal organs. Manganum is similar to Nitrate of Silver, causing laryngeal symp- toms, particularly in anaemic or tubercular patients. The hoarse- ness is usually worse in the morning and grows better as they succeed in hawking up lumps of mucus. The Manganum patient has cough from loud reading, with painful dryness and roughness of the larynx. The cough is usually relieved by lying down. Selenium is also similar to Argentum nitricum. Paris quadrifolia is a neglected drug in laryngeal affections. We find it indicated when expectoration is mostly noticed in the morning and when it is green and tenacious. ARGENTUM METALLICUM. 579 Nitrate of Silver may be used in ulceration of the cervix of the uterus when it is enlarged and indurated, with copious yellow, corroding leu- corrhcea and frequent bleeding from the points of ulceration. Next, I would refer you to the action of Argentum nitricum on the kidneys, because attention is not paid to this action of the drug. I think that it was Dr. Preston, of Norristowu, who used the drug mostly in such cases. He gave it very frequently in nephralgia from congestion of the kidneys or from passage of calculi. The face is of a rather dark hue and has a dried-up look; there is dull aching across the small of the back and also over the region of the bladder. The urine burns while passing and the urethra feels as if swollen. There is sudden urging to urinate. The urine is dark and contains blood, or else renal epithelium and uric acid deposit It is especially useful when Can- tharis, which it resembles, fails. Nitric acid is to be thought of for urinary calculi when the urine contains oxalic acid and when the substance is the principal ingredient of the stone. Lastly, I have to speak of the action of Argentum nitricum on the bowels. Here it is very similar to Arsenic. The stools are green and shreddy and consist of blood, slime and epithelium. This is often associated with the discharge of a great deal of flatus and is often provoked by the use of sugar. Especially is it indicated when diar- rhoea follows any excitement or when the imagination has been played upon. The bowels are apt to move as soon as the least food or drink is taken. In cholera infantum it is indicated in children who are thin, dried-up looking, almost like mummies. The legs are apparently nothing but skin and bones. The stools are green and slimy, with noisy flatus, and are worse at night. Natrum mur. is the proper remedy to antidote the abuse of Argen- tum nitricum. Argentum Metallicum. Argentum metallicum produces spasms which simulate those of epilepsy. The attacks are followed by delirious rage. The patient jumps about and tries to strike those near him. It produces spasmodic pain in various parts of the body; thus it gives rise to pain in the head, which gradually increases and, after reaching its acme, suddenly ceases. This pain is usually on the left side and is often associated with vertigo. The patient is extremely 58o A CLINICAL MATERIA MEDICA. forgetful. The heart muscle sympathizes in these neuralgic pains. Thus, there will be spasmodic twitching of the heart muscle, particu- larly when the patient is lying on his back. Now, the debility which naturally follow's is very easily understood if you remember one quality of the Argentum metallicum, and that is its action upon joints. It has a particular affinity for the cartilages of joints. Thus, we find general debility, with bruised feeling in the small of the back from the weakness of the spine, general weariness forcing the patient to lie down to obtain rest. The knees are particu- larly weak. There will be, not a true articular rheumatism, but an arthralgia, with pains of the same character as those of the head. All these symptoms are common enough. We find them in nervous, hysterical women and in men after loss of fluids, particularly semen. Argentum metallicum acts upon the mucous membrane of the throat and larynx. It produces a copious exudation of mucus in the larynx. This exudation is of pure mucus, not purulent or not serous, but look- ing just like boiled starch. It is associated with burning and rawness in the larynx, which rawness and burning are excited by talking and protracted use of the voice. The mucus is easily expectorated. Argentum metallicum acts upon the left ovary, causing bruised pain in that organ and, sometimes, a feeling as though the ovary was grow- ing large. This is a purely subjective sensation. Associated with this bruised pain there is often a prolapsed uterus. LECTURE LVIII. PLATINA, PALLADIUM, AND ALUMINA. Platina. f Mental symptoms.—Bell., Pallad., Phos. Nervous system.—Bell., Helon., Stan., Plumb. ( Pallad., Arg. met., Helonias, i Sexual organs. < _ , « , . & / Puis , Phos., Aurum. Platina. The action of Platina is to be studied under three headings, namely: The mental symptoms, its action on the nervous system in general, and its effects on the sexual organs, it acting upon both the male and the female organs. The Platina patient is rather haughty and proud, ego- tistical. She seems to look down upon everybody and everything as beneath her {Lycopodium has haughtiness). There is often accompany- ing this mental condition a peculiarity of vision; objects look smaller to her than natural. Platina also produces a similar excitation of the mind and of the whole nervous system. Everything seems strange to the patient. Things seem horrible to her. In her imagination she sees ghosts, demons, etc. Here it resembles Kali bromatum and Hyos- cyamus, both of which have this symptom. When she enters her own home objects appear strange to her; she does not know where she is. At other times the patient is decidedly melancholy. She thinks that death is near at hand and she fears it. Here it is very much like Arsenic and Aconite. Aconite predicts the hour or time of death, but otherwise the two drugs differ immeasurably. She may have a de- cidedly hysterical mood, with alternation of attacks of laughing and crying, especially when these are respectively inappropriate. Now these mental symptoms seem to depend upon excitement in the sexual sphere. The genitals, particularly those of the female, are acutely sensitive. There is constant titillation or tingling in the sexual organs, internally and externally. This excites the unfortunate victim to such a degree as to produce that horrible disease known as nymphomania. (When, as will sometimes happen, nymphomania occurs as the result of worms escaping into the vagina and there exciting irritation, Cala 582 A CLINICAL MATERIA MEDICA. dium is the remedy.) The patient seems to have the strength of a giant. She wishes to embrace everybody. These nymphomaniac symptoms are accompanied by prolapsus with induration of the uterus, just like Aurum. The ovaries are very sensitive, and are the seat of burning pains. Platina has even succeeded in curing ovaritis when pus has formed, and Hepar and Lachesis have been insufficient to effect its evacuation. The menses are too early and too profuse, and consist of dark, stringy, clotted blood. They are accompanied by spasms, or by painful bearing-down in the uterine region. Now these spasms of Pla- tina are quite frequently met with in hysterical subjects. They consist of a sort of tetanic rigidity with trismus, and this alternates with dyspnoea. This menstrual flow of Platina brings to mind two or three other remedies, which are here deserving of mention. Crocus has a dark or black clotted flow7, with or without miscarriage, and associated with a sensation as if there was something moving around in the abdomen. Chamomilla has profuse, dark, clotted menstrual flow, but its mental symptoms are different from those of Platinum. Millefolium and Sabina have bright-red, partly-clotted blood. Belladonna, like Platina, has a sensation in the forehead as if all would come out; face burning red; bearing down in uterus, etc.; but in Belladonna the pains come and go suddenly, and the flow is bright; or, if dark, it is offensive in odor. The Platina patient often suffers from neuralgia in various parts of the body. These neuralgias are very easily studied on account of their well-marked characteristic symptoms. The pains are of a cramping character, and cause numbness and tingling in the parts affected. You find them frequently in the head. There will be pain at the root of the nose, as though the part were squeezed in a vise, and this is fol- lowed by tingling and numbness, which will indicate to you that it is in the course of the nerves that this symptom lies. The pains increase gradually, and decrease just as gradually as they came, as you will find under Stannum. Now, in these neuralgic symptoms, the nearest remedy we have to Platina is Belladonna. In both remedies there is decided congestion of the head, with bright red face and delirium, but the gradually increas- ing, and just as gradually decreasing, pains distinguish Platina from Belladonna. Capsicum is suited to patients of lax fibre who suffer from burning PLATINUM. 583 pungent pain in the face, worse from the slightest draught of air, whether warm or cold. Verbascum is indicated in prosopalgia when there is a crushing as with tongs in the painful parts, worse from talking, sneezing, change of temperature, and daily from 9 A. m. to 4 p. m. Arsenicum has prosopalgia, w7ith darting, needle-like, burning pains. I have yet a few words to say about the action of Platina on the male system generally. We find it indicated for the ill-effects of prepubic masturbation. It is called for by the melancholy and the sheepish look that the children have. Also when, as a result of this unnatural vice, spasms of an epileptiform character appear. The youth has hollow eyes and yellow skin. During the attack the face is pale and sunken; in fact, it may be so at all times. Consciousness is not often lost. The limbs are usually drawn up and spread apart. It may also be used for spasms during labor. Teething children may require Platina when they are anaemic and pale; the jaws are locked, and after the spell the child lies on its back with flexed legs and knees widely separated. The spasms, both in adults and children, alternate between convulsive actions and opisthotonos. Women require Platina in convulsions when they have profuse, dark menses, and are proud and haughty, etc. Platina may also be used in hysterical spasms or spasms caused by nervous excitement, when they are preceded or followed by constriction of the oesophagus and respiratory embarrassment, a sort of asthma in other words; sudden arrest of breathing when walking against the wind. In this last symptom it is similar to Calcarea ostrearum and Arsenicum. Moschus is similar to it in hysteria. In its abdominal symptoms, Platina very much resembles Plumbum, and it has been used very successfully for the cure of the well-known colic produced by the latter remedy. Like Plumbum, Platina produces a constipation from inertia of the bowels. It is attended with frequent unsuccessful urging to stool. The stools when passed seem to be like putty or glue, and adhere tenaciously to the anus. It has been highly recommended for the constipation of emigrants. The Chloride of Platinum has only one symptom that I care to men- tion, and that is caries of the tarsus. You may use it in syphilitic cases, or after the abuse of mercury. Platina has some action on the female genital organs, as I have already intimated. It is useful in cases of indurated and prolapsed uterus, asso- ciated with continual pressure in the groins and back; parts are pain- 584 A CLINICAL MATERIA MEDICA. fully sensitive to touch. The patient exhibits sensitiveness, even vagin- ismus, during coitus. In indurated uterus compare Sepia, Aurum (which has more suicidal mania), Argentum nitricum and Helonias. For sensitiveness to coitus compare Sepia, Belladonna (from dry vagina), Kreosote (when followed by bloody flow), Ferrum, Natrum mur., Apis (when associated with stinging in ovaries), Thuja, etc. Palladium. Palladium is chemically and symptomatically near to Platina. It is of use principally for its action on the female genital organs. Its characteristic mental symptoms seem to find origin in the sexual symptoms, and form, with the latter, a useful and precise group for practical use. The patient is inclined to weep. She suffers from mental excitement, particularly in company. She always has an ag- gravation of her symptoms the day following an evening's entertain- ment. She is easily put out of humor, and is then inclined to use pretty strong language. She imagines herself very much neglected, and as she attaches great importance to the good opinion of others, this annoys her very much. The Platina woman is very different. She is egotistical in another form. Under Palladium'., pride is easily wounded. In Platina the patient is haughty and egotistical; she looks down on others as not being good enough for her. Palladium has a very characteristic headache, which makes the pa- tient very irritable. It extends across the top of the head from ear to ear. The face is sallow, with blue rings around the eyes. There are also nausea, usually worse in the evening, and very acid eru.tations. The bowels are constipated, the stools often being whitish in color. We come now to the special uterine symptoms of Palladium, and these we find quite numerous. They are as follows: Soreness in the abdomen with downward pressure, a very common symptom in uterine diseases; pain in the uterus and bladder after any exertion during the day; knife-like cutting pains in the uterus, which are relieved after stool; constant tired feeling in the small of the back; she is so tired that she actually reels; she feels drowsy; she complains that she feels sore and bruised all over; heaviness as from lead deeply seated in the pelvis, worse from any exertion, and worse standing; walking is much less irksome to her than is standing; lying on the left side relieves; swelling in the region of the right ovary, with shooting pains from navel into the pelvis, and with this there is bearing down, relieved by alumina. 585 rubbing. Jelly-like leucorrhoea. These local symptoms, together with those of the mind, make up the complete Palladium picture. Argentum metallicum, like Palladium, has affections of the ovaries and uterus. It is useful in prolapsus uteri when accompanied by symp- toms of the left ovary. The special characteristic sensation in Argentum metallicum is a feeling as though the left ovary was growing enormously large. Still another drug is Lilium tigrinum. This resembles Palladium and Platinum both, and you will have to keep these three remedies together in your minds. They all have irritability, " easily angered," and " things don't go right," but only Palladium has this over-sensitiveness to offence, and only Platinum has hauteur. Helonias is also similar to Palladium. It has the irritability, the sore- ness and, above all, a feeling of " tiredness." Blood. Nerves. Mucous mem- branes. Glands. Stomach, liver and bowels. Genitals. Larynx. Skin. Alumina is a form of pure clay and is known as argil/a. According to Hering, the symptoms which Hartlaub obtained are not pure, because he simply washed his preparation of clay, while Hahnemann subjected his to a red heat. You notice by the table on the board that I have placed Bryonia as the complement of Alumina. This is particularly true of the gastric symptoms. These drugs follow each other well in gastro-enteric affec- tions. Bryonia, also, acts as an antidote to Alumina, as does also Chamomilla. I have placed several of the concordant remedies with a few words in parenthesis to indicate the points of resemblance. Thus Pulsatilla is marked with chlorosis and ozaena, showing that in these Alumina. Puis, (chlorosis, ozaena), Calc. ostr. (fears crazy), Lach. (worse awak- ing), Sepia. Plumbum (colic). Alumina. \ Arg. n., Nux v., Sulph. (spine). Mercurius (bubo). Bry., Cham, (stomach). Ruta, Con., Natr. m., Sep., 3ryonia. Graph., Zinc Eyes. >Cham. >Bry. 586 A CLINICAL MATERIA MEDICA. two affections particularly, Pulsatilla is concordant with Alumina. Then you notice that Plumbum is similar to it in colic, and Nux and Sulphur in spinal affections, etc. Alumina acts best in aged persons of spare habits, who are rather wrinkled and dried-up looking, or in girls at puberty, especially if they are chlorotic, and also in delicate or scrofulous children, particu- larly children who have been artificially fed—that is, nourished by the many varieties of baby foods with which the market is glutted. Such children are weak and wrinkled; nutrition is decidedly defective. The bowels are inactive. This constipation is characteristic There is a great deal of urging to stool even though the faeces be soft, showing you at once that the inactivity of the bowels is the main influence at work in its causation. Here, we have it exactly like Bryonia. The child suffers from ozaena or chronic nasal catarrh, with a great deal of dryness of the nose. This you know by the dry sniffling sound which the child makes in breathing through its nose. The child, too, when teething, may suffer from strabismus. This comes from weakness of the internal rectus muscle of the affected eye. This symp- tom is sometimes curable by medicine, and when it is so, this method is preferable to any surgical procedure. Sometimes, it follows worms. Then Cinq is the remedy; when it comes from brain irrita- tion, Belladonna; and Cyclamen when from menstrual or gastric irregu- larities. The Alumina patient is very low-spirited and inclined to weep, like Pulsatilla, and this low-spiritedness is worse on awaking, here resem- bling Lachesis, Pulsatilla, Sepia, etc. At other times, you find the patient troubled with an apprehensive state of mind, a fear that he will go crazy, and this is an exact counterpart of Calcarea ostrearum. Iodine, etc. This shows you the irritable state of brain fibre. Another peculiarity that may be present, particularly in hysteria, is suicidal tendency when the patient sees blood, or a knife, or something of that kind. Men in whom Alumina is useful are hypochondriacal. There is a great deal of lassitude and indifference to labor or work. An hour seems to them half a day. They are exceedingly peevish and fretful; and here you find Alumina rivalling Nux vomica and also Bryonia. Now, on the right of the board, you will notice several headings under which I propose to consider Alumina. First, what changes are made in the blood by Alumina? I cannot tell you how it alters the blood, but there are diseases of the blood to which, it is applicable, and it is ALUMINA. 587 convenient here to bring these to your notice. We find it indicated in anaemia, and also in chlorosis, especially in young girls at puberty, when the menses are pale and scanty, and there is an abnormal craving for certain indigestible articles, such as slate pencils, chalk, whitewash, etc. The leucorrhcea to which they are subject is usually transparent, or else is composed of yellowish mucus, which is profuse, sometimes running down the limbs to the feet, and quite ropy and tenacious. This exhausts them very much, because it is rich in albumen. With these symptoms, you will almost always find the mental states that I have given you. Now in nervous affections. Alumina has been used in nervous affec- tions of a very grave character. Boenninghausen used the metal Alu- minium for the following symptoms in that dreaded disease, locomotor ataxia: Frequent dizziness; objects turn in a circle. There may be ptosis, diplopia or strabismus present. The patient cannot walk in the dark or with his eyes closed without staggering. He feels as if he were walking on cushions. There is formication, or sensation as from creeping of ants in the back and legs. The nates go to sleep when sitting. The heels become numb when walking. He has a feeling in the face as though it was covered with cobwebs, or as though the white of an egg had dried on it. He may also complain of pain in the back, as though a hot iron were thrust into the spine. These are the symptoms indicating Alumina, and these are the symptoms which led Boenninghausen to Aluminium, and enabled him to cure four cases of the disease. Next, the mucous membranes. Alumina is a unique drug here. It acts in a limited but very well-described class of cases. It causes un- mistakable dryness of the mucous surfaces. If you keep that fact in mind you can explain all the symptoms which it causes. You have at once the key to its dyspepsia, nasal catarrh, sore throat and constipation. There is dryness of the mucous membranes. After a while, there is formation of mucus, which is thick, yellow, and very difficult of de- tachment. Let me show you a few illustrations of this. In the eyes, for instance, we will have it indicated in blepharitis particularly, with great dryness of the conjunctiva. The lids feel stiff; the lids crack, so dry are they. The nearest analogue here is Graphites, which has the same symptoms, only it has more bleeding than has Alumina. Alumina is useful in asthenopia from irritated conjunctiva; also in granular lids and chronic blepharitis. 588 A CLINICAL MATERIA MEDICA. For dry eyes, Allen recommends, also, Berberis, Natrum carb., and Natrum sulph. Eyes dry on reading, Crocus, Argentum nitricum. Drooping eyelids, Nux moschata, Sepia, Rhus. Alumina also has loss of power over the internal rectus. Here it is like Conium, Ruta, and Natrum mur. The latter, according to Wood- yatt, is the best. In nasal catarrh you will find Alumina indicated in children with great dryness of the nose, formation of scabs and remotely, thick, tena- cious yellow phlegm or mucus, which is difficult of removal. The cough indicating Alumina is dry and spasmodic. It is worse in the morning when the patient coughs until he detaches a small amount of tightly adherent mucus, when it is better for a while. You find it indicated in disease of the throat, in a relaxed condition of the mucous membrane, just that condition you meet with in clergy- men's sore-throat. The throat is very dry on waking with husky, weak voice. It is dark red, the uvula elongated. Hoarseness appears worse in the morning, with a feeling as of a splinter in the throat when swallowing. This last symptom you find also under Hepar, Argentum nitricum and Nitric add. The mucous membrane of the stomach is dry, and therefore, there is defective secretion of gastric juice." Here you have the same dyspepsia as is curable with Bryonia. The distinctive symptoms for Alumina are these: There is a feeling of constriction along the oesophagus when swallowing food. The patient is always worse from eating potatoes; that is a good symptom for Alumina. There is aversion to meat and a craving for indigestible substances. The liver is sensitive to touch, and there are stitching pains in that organ, as under Bryonia. You find the already described constipation with urging to stool, even though the stool be not dry and hard. Piles itch and burn, and are moist. Next, we consider the action of Alumina on glands. Here I have only one symptom for you, and that is the use of the drug in treating buboes. You may give it in gonorrhoeal bubo when there exists with it a yellowish gonorrhoeal discharge, with burning and itching along the urethra, particularly at the meatus. Lastly, the skin. Alumina acts on the skin just as it does on the mucous membranes, producing dryness and harshness of the skin; as a consequence, we find it indicated in rough, dry eruptions, which crack and may bleed, although not often, and which itch and burn intolera- bly, and are worse in the warmth of the bed. ALUMINA. 589 You will recall here that Argentum nitricum, Nux vomica, and Sul- phur, are similar to Alumina in spinal affections. You will find Mercurius the most similar remedy to Alumina in the treatment of bubo. Alumina has been used as an antidote to the colic caused by Plum- bum. LECTURE LIX. PLUMBUM AND STANNUM. Plumbum Metallicum. ( Belladonna, Platina, Nux vomica, Cuprum, Opium. Plumbum J (Opium. (China. > \ Alumina. The symptoms of Plumbum, or lead, may be studied from its main property, that is, its tendency to cause contraction of muscular fibre, both voluntary and involuntary. It will cause this contraction of muscles, and it will also cause contraction of the bloodvessels, because it affects the involuntary or non-striated muscular fibres. The first symptom that usually follows poisoning by lead, whether taken by the stomach in slow doses, as in case of drinking water impregnated with it, or whether by inhalation, as in the case of painters, is lead colic, and this consists of horrible griping cramp-pains, with retraction of the abdominal walls, making the abdomen concave rather than convex. There is understood to be spasm of the recti muscles; as these are con- tracted, of course they draw the abdominal walls in. Pain radiates in all directions, generally following the course of the nerves, sometimes causing delirium when extending to the brain, dyspnoea when involv- ing the chest, retraction of the testicles when extending in that direc- tion, and violent cramps in the legs when reaching the nerves there. With this colic there is obstinate constipation, and in some cases, even stercoraceous vomiting. The colic is antidoted by Alumina, Alum, Platina, Opium, Nux vomica, or Belladonna, and is prevented by alcohol. Next the symptoms of Plumbum that are of a paralytic character. The first characteristic symptom here is wrist-drop from paralysis of the extensor muscles of the wrist. This Plumbum has cured when it has arisen from other causes than lead-poisoning. This paralysis ex- tends to other parts of the body, always involving extensor muscles in preference to flexors. There appears on the border of the gums a blue line, known as the gingival line. It is caused by the sulphur that PLUMBUM. 591 exists in the tartar on the teeth combining with the lead in the blood- vessels, and forming a deposit of insoluble sulphide of lead. As I have said, the paralysis extends and involves other parts of the body, and then you have this to characterize it: Paralysis, with atrophy of the affected parts, hence due to true organic changes. Thus you find Plumbum indicated in paralysis of organic origin; in paralysis from disease of the spinal cord when that nervous structure has undergone fatty degeneration or sclerosis. Plumbum suits very nicely that disease known as multiple cerebro- spinal sclerosis. It is indicated by this symptom: Tremor, followed by paralysis. We often find Plumbum indicated in paralysis with contracture. Progressive muscular atrophy may also call for Plumbum. ' Lead tends to produce non-development of the uterus. We may, therefore, find it indicated in cases of tendency to abortion. The foetus in utero grows, but the muscular fibres of the uterus do not develop in proportion, hence the uterus is no longer able to accommodate the growing foetus and abortion ensues. Sometimes we find Plumbum indicated in delirium, this delirium alternating with the colic. It is very much like that of Belladonna; the patient bites and strikes at those near him, but it differs from that of Belladonna in this: There is tremor of the head and hands, and yellow mucus collects about the mouth and teeth. The delirium, moreover, alternates with colic, which is not the case in Belladonna. Other cerebral disturbances from lead-poisoning are not common, but still the following may be met with: Insomnia, severe headache, either occipital or frontal, with or without vertigo; noises in ears; dis- ordered vision; diplopia; amaurosis; contraction of pharynx, though liquids are swallowed in gulps and greedily; mind weak, morose, and sad; preceded by albuminous urine. Plumbum has frequently caused epilepsy. The characteristic symp- toms which indicate it are these: Almost paralytic heaviness of the legs before the attack, and paralysis and prolonged snoring sleep after- wards. It is especially indicated in convulsions from cerebral sclerosis or tumor. In constipation you may use Plumbum when there is present the retraction of the abdomen already mentioned, and when there is marked spasm or contraction of the sphincter ani. There is urging to stool, and the patient complains of a sensation as though a string were draw- ing the anus up into the rectum. 592 A CLINICAL MATERIA MEDICA. In its action on the kidneys Plumbum produces granular degenera- tion or cirrhosis of those organs. There is very little dropsy or albu- minuria, but a marked tendency to uraemir convulsions. Stannum. f Causticum. \ Phosphorus, Sulphur. Sepia, Pulsatilla, etc. V Pulsatilla. Nerves. < Exhaustion. Paralysis. Spasms. (^ Neuralgia. Mucous membranes. Fevers. Organs. Stannum is a drug that has not many symptoms, hence it can be dis- posed of very quickly. Its complement is Pulsatilla. The Stannum patient is usually sad and lachrymose, just like Pul- satilla. Crying usually makes the patient worse. This low-spirited- ness is found in the lung troubles for which Stannum is your remedy. This is rather different from the usual mental state of consumptives, who, you all know, are generally hopeful, almost to the last hour of life. Stannum is particularly indicated when they are low-spirited, hence it is rarely indicated in true tuberculosis. The woman for whom Stannum is indicated is also nervous and weak; so nervous, irritable, and weak is she, that she becomes anxious and has palpita- tion of the heart, even from so little exertion as giving directions con- cerning her household affairs. She complains of a sensation of gone- ness in the stomach and chest. This nervous exhaustion is exhibited in various ways; it is particularly induced when the patient goes down stairs, more than when ascending. She feels as if she could not walk down stairs, or as if she had not sufficient strength in her limbs. You may see this exhaustion in another way: The patient does not com- plain much about walking, but on trying to sit down she fairly drops into the chair. This is not an imaginary symptom. You will meet it in uterine affections. In the mental symptoms you may compare Stannum with Natrum mur., Pulsatilla, and Sepia. Natrum mur. has melancholy, sad, weep- ing mood. Consolation seems to aggravate. On trying to comfort him, he becomes enraged. The Pulsatilla patient is of a mild, tearful, yielding disposition. STANNUM. 593 She rather likes consolation. She has scanty, delayed menses, while Stannum has the opposite. The Sepia patient has sadness concerning her own health, while she exhibits great indifference to her family. She is easily offended and is inclined to be vehement. In this relaxation of tissue, producing goneness or weakness, we have several remedies. First of all, when you find patients are weak from talking, compare the following remedies: Cocculus, Veratrum alb., Sulphur and Calcarea ostrearum. For the functional paralysis that may come from fatigue or from mental emotions, compare with Stannum, Cocculus, Ignatia, Phospho- rus, Natrum mur. and Collinsonia. The Stannum patient is troubled with disordered digestion, other- wise called dyspepsia. There are nausea and vomiting in the morning, or the odor of cooking causes vomiting. This last symptom is a par- ticularly strong indication for Stannum, especially in women. There is weak, gone feeling in the stomach, as in Sepia; also bitter taste in the mouth. The rectum is inactive. Much urging is required to evacuate even a soft stool. The face is apt to be pale and sunken, with dark rings around the eyes. These symptoms indicate debility, with which women suffer, and they are the symptoms of worms. They may call for the exhibition of Stannum when worms are present. It may be indicated even'when convulsions result from the irritation of these parasites, thus placing it alongside of Cina, Artemisia, etc. Men may require Stannum when they are hypochondriacal. They have gastralgic pains, which compel them to walk about for relief, and they are so weak that this exercise is very fatiguing to them. The tongue is coated yellowish. The Stannum patient suffers from prolapsus uteri. This prolapsus so often calls for Stannum, that Dr. Richard Hughes generally finds it useful for simple prolapsus uteri. You will find, too, that under Stannum the vagina is prolapsed. These prolapsus symptoms are worse during stool. The menses are always profuse. The leucorrhcea corresponds with the prevailing character of the drug. It is yellow- ish or else it is clear mucus, and is always associated with unbearable weakness. The patient is so weak that she can scarcely move about. The prostration is so great that, on dressing in the morning, she has to sit down several times to rest. There is trembling of the arms and legs. The limbs feel as heavy as lead. This weakness is always worse when descending, as when going down stairs or assuming a sitting 38 594 A CLINICAL MATERIA MEDICA. •posture. These uterine symptoms may be associated with weak or gone feeling in the chest. The patient feels so weak she can scarcely talk. As somewhat similar to Stannum in prolapsus uteri, with aggravation of symptoms during stool, you may remember Podophyllum, which has prolapsus uteri with diarrhoea. The stool is usually green, and comes with a rush. As you might expect, a patient, so thoroughly weakened as to the ner- vous system as is the Stannum patient, must suffer from neuralgia. The general characteristic guiding you to its use is, the pains increase and decrease slowly. They are especially liable to occur in the course of the supra-orbital nerve. With this character to the pain, we find Stannum useful in prosopalgia following intermittent fever and abuse of quinine. In these pains that increase and decrease slowly, the nearest remedies are Platina and Strontiana carb. Epilepsy has been treated with Stannum, particularly when reflex from abdominal irritation, as from the presence of worms in the intes- tinal canal. The patient has a pale face and dark rings around the eyes, and colic, which is relieved by pressing firmly on the abdomen. If the child is old enough to describe his sensations, he will complain of a sweetish taste in the mouth. It is also useful in epilepsy with sexual complications; opisthotonos; clenching of the-thumbs. Hysterical spasms may also call for Stannum, especially when asso- ciated with pain in the abdomen and diaphragm. Next, the action of Stannum on mucous membranes. When it is the remedy, you find that there is copious secretion from the mucous membranes. This is bland and unirritating, and is yellowish or yellowish-green; hence it is a muco-purulent secretion. Sometimes, although not so often, this mucus is tenacious, viscid and intermixed with blood, accumulates in the throat and is detached with great diffi- culty, even exciting vomiting. The mucus collects very rapidly in the chest and is quite easily expectorated, with great relief to the patient. The oppression, the weakness, and the tightness of the chest are all re- lieved when this sputum is raised. The voice, which is husky and hoarse, seems to be raised in pitch by this expectoration. Dyspnoea, too, is decidedly better after expectoration. The cough is very annoy- ing and teasing. It is worse at night, and is excited by talking and walking rapidly. The patient, in addition, complains of that weakness of the chest. It seems as if he had no strength there whatever. Dys- pnoea comes on, worse towards evening. STANNUM. 595 Now these are the symptoms which indicate Stannum in cases of neglected cold. They also suggest the drug in what has been very properly termed catarrhal phthisis. There is marked hectic fever. The chills come characteristically at ten o'clock in the morning. Towards evening the patient becomes flushed and hot, with aggrava- tion of his symptoms on any exertion. At night he has profuse sweat, which is particularly worse towards four or five o'clock in the morning. Let me say here that in this hectic fever, with chill at ten o'clock in the morning, I have several times tried Natrum mur., but without obtaining any benefit from it. Stannum is a remedy which you must select with great care, or it will surely disappoint you. You must have the weakness present. When you find Stannum insufficient in catarrhal phthisis, you may think of the following remedies: Silicea is indicated in catarrhal as well as in true tubercular phthisis when there is cough, which is increased by rapid motion. There is copious rattling of phlegm in the chest. The expectoration is more purulent than that of Stannum. There are usually vomicae in the lungs. You will find Silicea frequently indicated in the catarrhal phthisis of old people. Phosphorus must often be carefully compared with Stannum, as the two remedies are frequently misused for each other. Both have hoarse- ness, evening aggravation, weak chest, cough, copious sputum, hectic, etc. Phosphorus has more blood or blood-streaks, tightness across the chest, etc. Senega is a drug which produces great soreness in the walls of the chest and great accumulation of clear albuminous mucus, which is difficult of expectoration. These symptoms are often accompanied by pressure on the chest as though the lungs were pushed back to the spine. It is especially indicated in fat persons of lax fibre. This Senega contains Senegin or Polygalic acid, which is identical in com- position with Saponin, the active principle of the Quillaya saponaria. This also produces the same kind of relaxed cold as the Senega does. Coccus cacti is useful in whooping cough, with vomiting of great ropes of clear albuminous mucus. It may be useful in catarrhal phthisis when, with this ropy phlegm, there are sharp stitching pains under the clavicles. Balsam of Peru is indicated in catarrhal phthisis by copious puru- lent expectoration. We know but little concerning this drug. We 596 A CLINICAL MATERIA MEDICA. must, therefore, adopt the expedient of selecting it by a process of ex- clusion. Yerba santa or the Eriodiction Californicum is indicated when there is asthmatic breathing from accumulation of mucus. There are con- siderable emaciation and fever. Among other remedies with much phlegm on the chest are, Anti- monium crudum and tartaricum, Chamomilla, Belladonna, Calcarea ostrearum, Calcarea phosphorica and Ipecacuanha (in children), Lyco- podium, Sulphur, Phosphorus, Balsam of Peru (purulent sputum), He- par, Scilla, Yerba santa (fever, emaciation, asthma from mucus), Co- paiva, (profuse greenish-gray, disgusting-smelling sputa); Illicium anisatum (pus, with pain at third cartilage, right or left); Pix liq. (purulent sputum; pain at left third costal cartilage); Myosotis (copi- ous sputa, emaciation, night sweat). In pleurisy you find Stannum indicated by sharp, knife-like stitches, beginning in the left axilla, and extending up into the left clavicle. Sometimes they extend from the left side down into the abdomen. They are worse from bending forward, from pressure and on inspira- tion. Stannum is sometimes used in functional paralysis arising from onanism or from emotions. Sometimes persons of the weak, nervous temperament I have described are so affected by emotions as to lose the power of motion. Here Stannum compares with Staphisagria and Natrum mur. LECTURE LX. CUPRUM AND ZINCUM. Cuprum Metallicum. i. Blood.— ' Sulphur. a. Chlorosis. Argentum nitricum, Arseni- b. Fever. cum, Veratr. alb. c. Heart. Cu Drum. - Colocynth, Plumbum, Cho-los terrapinae. Stramonium, Belladonna, 2. Nerves.— a. Spasms. b. Cramps. V >>. Hyos. c Neuralgia. Calc. ostr. f Sugar. | Albumen. d. Lack of reaction. e. Paralysis. 3- Collapse.— Cuprum metallicum and Cuprum aceticum are used interchange- ably by many physicians as having the same symptomatology. The original idea of those who proposed the substitution of the latter for the former was based on the supposition that the acetate of copper is soluble, while the metallic copper is not. This applies, of course, to the crude drug, but not to the potentized preparations. Copper has for its complement Calcarea ostrearum. It is antidoted by sugar and albumen. Hepar, as a general antidote to the metals, comes into play as a dynamic antidote, as do also Belladonna and Stramonium. Copper possesses considerable interest as a prophylactic in disease. Workers in copper seldom contract Asiatic cholera. Here it resembles Sulphur. Unlike Sulphur, however, it is a remedy for the symptoms of cholera. It is indicated for the following symptoms: Intense coldness of the surface of the body, blueness of the skin, cramps of the muscles, the muscles of the calves and thighs are drawn up into knots. There is considerable distress, referred by the patient to the epigastrium, and this is associated with most intense dyspnoea. So intense is the dyspnoea that the patient cannot bear his handkerchief approached to his face; it takes away his breath. Now, this picture of Cuprum seems to place it between Camphor and Argentum nitricum. Camphor has symptoms of collapse, like Cuprum; and Argentum nitri- 598 A CLINICAL MATERIA MEDICA. cum has terrible distress in the epigastrium with dyspnoea. It differs from Camphor in this: Camphor lacks the prominence of the cramps which are ever present in the collapse of Cuprum. There is another condition in which Cuprum may be used, and that is in the uraemia or uraemic convulsions following cholera. The char- acter of these convulsions will appear in a few minutes when I speak of the nervous symptoms of the remedy. We find Cuprum indicated in chlorosis, after the abuse of iron. The symptoms are worse in hot weather. We also find it indicated in fever with marked tendency to frequent relapses; hence, in a sort of relapsing fever. It is not the specific re- lapsing fever, but rather a fever in which the relapses are the result of defective reaction. Cuprum, when taken in large doses, produces an inflammatory colic, presenting a combination of neurotic with inflammatory symptoms; these are gastro-enteric We find the abdomen as hard as a stone; the bowels are, at first, obstinately constipated, the constipation being suc- ceeded at times by bloody, greenish, watery stools. The vomiting is terrific and is spasmodic in its character. It seems to be relieved by a drink of cold water. Here it is very different from Arsenicum, Veratrum and other remedies. Now, what takes place in this group of symptoms? In the first place, Cuprum not only acts on the bowels, inflaming them, but it acts upon the nerves, causing constriction of fibre, particu- larly of the involuntary muscular fibres, as in the bloodvessels, and with this we have direct irritation producing inflammation. Now, to clearly understand the character of Cuprum, you must remember the other side to this picture. This condition is soon followed by collapse with great prostration, from which it is exceedingly difficult for the patient to rally. Thus, we have as a remote symptom of Cuprum, and one, too, which has been greatly neglected, lack of reaction. We have seen that quite a number of remedies are useful in this condi- tion. We all know that Sulphur may often be used; we have learned under what circumstances Carbo veg. is called for; that Laurocerasus, Valerian and Ambra grisea are suited in some nervous temperaments; Capsicum in flabby, lazy individuals of lax fibre, and Psorinum in well-marked psoric cases. But here we have, when Cuprum is the remedy, a tendency of all the symptoms to relapse. Especially is it an indication when this lack of reaction occurs in persons who are thoroughly '' run down '' by overtaxing both body and mind. I know of a case in which Cuprum prevented paralysis of both legs, and this was the indication, overtaxing of both brain and body. zincum. 599 So, too, in pneumonia, we may have to use Cuprum to bring about reaction before the appropriate remedy will cure. It is indicated by sudden suffocative attacks, with coldness of the surface of the body, with great prostration and dyspnoea disproportionate to the amount of solidification. The body is covered with a cold viscid sweat. The main action of Cuprum and that wThich will call for its most frequent use in practice, is on the nervous system. We find it indi- cated, for instance, in spasms with affections of the brain, as in menin- gitis. No remedy in the materia medica excels it, and very few equal it, in this direction. We find it indicated when there has been an eruption suppressed, whether that be scarlatina, measles or erysipelas. The symptoms which call for it are these: Delirium of a violent char- acter very much like that of Belladonna, the patient bites the offered tumbler, loquacious delirium on awaking from sleep, or on becoming conscious he appears frightened. Here it is the exact counterpart of Stramonium. But it is a far deeper-acting remedy than Stramonium. The convulsions usually start from the brain with blueness of the face and lips, the eyeballs are rotated and there are frothing at the mouth and violent convulsive symptoms, especially of the flexor muscles. The convulsion is followed by deep sleep. Now this spasm, especially if epileptic, may be ushered in by a violent shriek or cry. There is grinding of the teeth. Cuprum is indicated not very frequently in neuralgia, but it may sometimes be used in sudden attacks of neuralgia with active conges- tion affecting the nervous supply of the involuntary muscles. Cuprum arsenicosum I have used in the third potency, on the recom- mendation of Dr. J. H. Marsden, for neuralgia of the abdominal viscera. I have prescribed it in cases in which no other remedy seemed to be indicated, and I believe with excellent success. Zincum. Nervous depression. Undeveloped diseases from enervation. ( Hemispheres. Brain. < Sensorium. (^ Pons medulla. Spine. Anaemia. Organs. Skin. Zinc. 6oo A CLINICAL MATERIA MEDICA. Zinc Belladonna, Cuprum, Stramonium. Hyoscyamus. Calcarea ostrearum. > Ign. Camphor. < Nux vom. Plumbum. > Hep. Zincum metallicum is the zinc preparation we most frequently use. You will notice the very peculiar fact that two preparations containing strychnia, Nux vomica and Ignatia, hold opposite relations to Zinc. Ignatia follows Zinc well, and may even act as an antidote to its effects on the nervous system. Nux vomica tends rather to increase the effects of Zinc, in fact is inimical to it. Hepar also antidotes Zinc, as it does every other metal. It is a safe remedy to fall back on in cases of me- tallic poisoning when the symptoms point to no special antidote. Zinc often precedes Apis when there are sharp cutting pains all over, coming quickly, jerks of tendons in sleep, head hot, feet cold; kidneys still act. I have had mapped out on the board some of the sphere of action of Zinc. I wish to impress on you all that this is not placed here as an ex- haustive analysis of the remedy, nor is it intended to teach you that you are to use Zinc only in the diseases here named. This table is only for convenience sake, to give a sort of starting point around which you may group the symptoms of the remedy. In poisonous doses the salts of zinc cause formication, that is, a sen- sation as of ants creeping over the body. This creeping or tingling is relieved by rubbing or by pressure. There is even a tremulous vibra- tion all through the body. This is experienced by the patient, and is noticed, too, by the observer. Later, there appear fainting spells, with a great deal of numbness and deathly nausea. As soon as water touches the stomach, it is vomited. This is increased by acids, so, if any one should give the patient vinegar or lemon-juice, it only adds to his tor- ment by increasing the nausea. With all this, there is vertigo. The head reels, the eyes feel as if they were being drawn together, and there is hard heavy pressure at the root of the nose. These symptoms are followed by convulsions and stupor, and finally, if the poison cannot be antidoted, by death. I would w7arn you, too, if you meet with such a case of poisoning, do not give wine or other stimulants, for every symptom of Zinc, from head to foot, is made worse by wine. Other remedies having aggravation from drinking wine are Rhodo- ZINCUM. 601 dendron, Glonoin, Nux vomica, Selenium, Ledum, Fluoric acid, Anti- monium crudum and Pulsatilla. Glonoin has congestive headache, made worse by wine. Ledum is indicated in drawing pains in the joints, made worse by drinking wine. Fluoric acid has aggravation from red wines. Pulsatilla from sulphurated wines. Antimonium crudum is suited to the bad effects of Rhenish sour wines. Bovista, easily intoxicated. Silicea, ebullition of blood, with aggravation from wine. Workers in zinc, after ten or twelve years' exposure, suffer from the following symptoms: Pains in the back; sensitiveness of the soles of the feet; formication, numbness and coldness of the legs; sensation as of a band around the abdomen; crampy twitching of the muscles. Reflex excitability is increased so that irritation in one part of the body will produce violent jerking in another. Muscular sensibility is lessened, hence patient staggers when his eyes are closed, or when he is in the dark. There are muscular tremors which almost simulate those of shaking palsy. Still later, the gait becomes stiff, motions are spasmodic with the step on the full sole. From involvement of the sympathetic nervous system there are anaemia and progressive and general emaciation. In studying Zinc as a remedy we are to remember, then, that it is a medicine which acts prominently on the nervous system. This influ- ence which it has on the nervous tissue, is one rather of depression than stimulation. It weakens the cerebro-spinal nerves, and also those of the sympathetic, or ganglionic nerves more accurately called. It is, therefore, to be used in those diseases in which there is weakness of the nervous system. One very useful condition in which we may em- ploy this drug comes under the second heading, undeveloped disease from enervation. By that I mean that Zinc is an invaluable drug when the patient is nervously too weak to develop a disease, and hence he suffers all the consequences of hidden disease, or disease spending its force on the internal organs. To give you an illustration of this in exanthematous diseases, we find Zinc called for in scarlatina, or in measles when the eruption remains undeveloped. As a result of the non-development of the disease, the brain suffers, as we shall see presently. Now, as another evidence of this nervous condition of non-reaction, 602 A CLINICAL MATERIA MEDICA. we find pains in the ovaries which are relieved during the menstrual flow. Another illustration of this action of Zinc will be found in the catarrhal asthma in which it is indicated. This asthma is accom- panied by great constriction of the chest ( Cadmium sulph., Kali chlor. and Cactus g.), and is relieved as soon as the patient can expectorate. So, too, in the male organs there is a local irritation which may be the result of spinal irritation, or self-abuse. This irritation is relieved by a seminal discharge. Again, during dentition, the child gives way under the nervous strain, the teeth fail to develop. It has a slow pulse, seeming to come in long waves; it is drowsy, and lies with the back of the head pressed deeply into 'the pillow, with the eyes half-closed and squinting, the face pale and rather cool, or alternately red and pale. The child gives forth loud cries, not exactly the cri encephalique, but something akin to it, with trembling all over, boring the fingers into the nose (as you find under Cina, Arum triphyllum, Veratrum and a few other remedies), or pulling nervously at the dry, parched lips. That will remind you of Arum triphyllum, too. There will be automatic motion of different parts of the body, usually the arms and hands, and, par- ticularly, restless, fidgety movements of the feet. That last is a very strong indication for Zincum. If still conscious enough to take water, he drinks it hastily. In extreme cases the abdomen is hot and sunken, and the stools and urine involuntary. In milder brain symptoms the child awakes delirious, as if frightened by horrible dreams. It seems to know no one. It rolls the head from side to side. It may have convulsions, with anxious screams and springing up out of bed, gnash- ing the teeth and rolling the eyes. The child is exceedingly cross and irritable before the attack, with hot body and great restlessness, partic- ularly at night. Zincui7i may be indicated in chorea or St. Vitus' dance, when caused by fright or suppressed eruptions, especially when the general health suffers very much. There are great depression of spirits, and irritability. Still another form of cerebral trouble calling for Zinc is meningitis. Here it is indicated when, in the beginning either of a case of rheu- matism, or in fact from any cause, you find these sharp, lancinating pains through the head; they are worse from wine,* or from anything *In headache worse from wine, compare: Rhododendron, Glonoin, Nux vomica, Oxalic acid and Selenium. Both Conium and Zinc have aggravation from small sips of wine; Conium is easily intoxicated thereby. Zinc has nearly all symptoms by taking small quan- tities. ZINCUM. 603 that stimulates. There are, also, pressing, tearing pains in the occi- put, particularly about the base of the brain; and these pains seem to shoot through the eyes, and, sympathetically, into the teeth. There is a very distressing, cramplike pain at the root of the nose, just as we found in the poisoning symptoms. Now these symptoms will suggest Zinc to you in quite a variety of ailments, but especially in meningitis arising from the non-development of an eruption. So you find Zincum indicated in scarlatina with the brain symptoms that I have mentioned, and with the following additional symptoms: The eruption is imperfectly developed; the skin is rather livid; the child is restless and delirious, or else quiet and unconscious; even in the smooth or Sydenham scarlatina, Zinc may supplant Belladonna by reason of this enervation of the child. A still worse case than this may occur, and still Zincum be indicated, and that is, when the skin is bluish and cold, the body is heavy, and the pulse is almost thread- like, it is so weak and volumeless. Let us now compare Zincum with other remedies. Cuprum has cerebral symptoms, convulsions with screaming out, clenching of the thumb into the palm of the hand, boring of the head into the pillow, and predominant spasm of the flexor muscles; the face is usually red, or even purple; the teeth are clenched; the child foams at the mouth; it awakens from its sleep frightened, and does not know anybody about it, just as in Zincum and Stramonium. All these symp- toms in Cuprum are the result of a suppressed eruption. In the Zinc they are due to an undeveloped eruption. The symptoms are more violent under Cuprum; they are more like those of active inflamma- tion. In the Belladonna scarlatina the case is different. Belladonna is indicated in the smooth variety of scarlatina, in the early stages. The vomiting is violent, and the cerebral symptoms prominent. There are screaming out, wild look about the eyes and redness of the face. The throat is bright red and swollen, and the tongue covered with elevated papillae; the patient springs up from sleep screaming, and clings to those about it. Suppose, however, this case goes on, and the rash does not come out; the child becomes pale and livid; it rolls its head in the pillow, grinds its teeth, and screams out whenever you move it, and the feet are restless; then Belladonna, Cuprum or Lachesis will do no good; no remedy but Zinc will. If the case goes on in spite of Zinc, and the skin becomes livid and 604 A CLINICAL MATERIA MEDICA. cold, the pulse filiform, Camphor may still bring about reaction, espe- cially if there is cold sweat. In some cases Veratrum album will come in. In still others I would have you remember Hydrocyanic acid. Calcarea ostrearum is often forgotten in scarlatina. It is to be placed alongside of Zinc, particularly in scrofulous children, when the rash is either undeveloped, or else recedes, leaving the face unnaturally pale and bloated. Zincum is indicated in several forms of headache. One of them is a stinging, tearing headache, worse in the side of the head, greatly in- creased by wine; this headache is also w7orse after dinner. Sometimes you will find Zinc indicated in obstinate pain in the head, obstinate in its persistence, yet intermittent in its quality, now very severe, and now fading away, but continually returning. It is also indicated for hypochondriasis and pressure on the top of the head, increased after dinner. You will also find Zincum indicated in hydrocephaloid, following cholera infantum. The child rolls its head; it awakens from sleep as if frightened, and looks around the room terrified; the occiput is apt to be hot and the forehead rather cool; there is grinding of the teeth; the eyes are sensitive to the light, and are fixed and staring; the face is sunken and pale, or alternately red and pale; the nose is dry; there is jerking of the muscles during sleep; and last, but not least, there is constant fidgety motion of the feet. In hydrocephaloid, Zincum is closely allied to Calcarea phos. Next, I would like to speak of the action of Zincum on the spine. Zinc is a good remedy in diseases of the spine of a functional character, especially in spinal irritation. The symptoms which call for it are these: First and foremost, dull, aching pain about the last dorsal or first lumbar vertebra, and this is worse when the patient is sitting than it is when he walks. That symptom, I can assure you, is a good indi- cation for Zinc. I think that very nearly the same symptom is found under Sepia. It is not situated in the same locality, however, but has the same aggravation. It is also found characteristically under Kobalt. This backache under Zincum is associated with burning along the spine, which burning I believe to be purely subjective and not conges- tive in character. We also find under Zinc, trembling of the limbs, with a feeling as if they were about to be paralyzed; sudden spasmodic bursting sensation about the heart; the heart seems to be beating reg- ularly, when it suddenly seems as if it would burst through the chest; ZINCUM. 605 constriction of the chest, causing shortness of breath; the pulse is slow, or weak and irregular; weakness or goneness in the stomach at 11 a. m. This last symptom you will also find'under Phosphorus, Natrum carb, Sulphur and Indium. Zincum is also indicated in paralysis from softening of the brain, following suppressed foot-sweat, with vertigo, trembling, numbness and formication. These symptoms are relieved by friction, and greatly aggravated by wine. There may be marked ptosis with this paralysis. In these paralytic affections, Zincum is similar to Phosphorus and Plumbum. It is similar to Phosphorus, in that both remedies suit cases of enervation and of softening of the brain with the accompanying trembling. Phosphorus has not the aggravation from wine or the ptosis. Plumbum has nearly the same symptoms as Zinc, but there is added to these, impaired nutrition, or atrophy of the paralyzed part. There will be pains in the atrophied limbs, alternating with colic. Now a word or two as to some local effects of Zinc, and we will have done with the remedy. First of all, we find it indicated in some affec- tions of the eyes; for instance, in amblyopia, accompanied by severe headache, which is probably dependent upon some organic change in the brain or its meninges, and with severe pain at the root of the nose. The pains are particularly worse at the inner canthus of each eye. The pupils are contracted. We may also use Zinc for opacities of the cornea following repeated and long-lasting attacks of inflammation of that membrane. The best preparation here is Zincum sulphuricum. Pterygium may be removed by Zinc, particularly if there are smart- ing and stinging pains at the inner canthus. Zincum is also useful for granular lids. Zincum sulphuricum is here preferable to the metallicum. It is also indicated in prosopalgia when the pains are severe and are accompanied by blueness of the eyelids. Zincum has marked gastric and hepatic symptoms. It produces bitter taste, which is referred by the patient to the fauces. As soon as a spoonful of w7ater reaches the stomach it is ejected. Heartburn is present, and this is increased by wine and also during pregnancy. When occurring during pregnancy it is apt to. be accompanied by vari- cose veins of the legs. Hunger is particularly manifested towards noon. Zincum also affects the liver. You will find recorded in the original provings a symptom, the exact language of which I have for- 6o6 A CLINICAL MATERIA MEDICA. gotten, but which is in substance this: There is a feeling as of a hard tumor in the neighborhood of the umbilicus, and this is accompanied by griping pains. This symptom has led to the use of the drug in enlargement of the liver. Zincum affects the abdomen something like Plumbum, producing griping pains about the navel, with most obstinate constipation. This is accompanied by a great deal of pressure backwards, as though the abdomen was being drawn back toward the spine Now, in almost all cases in which Zincum is useful you will find that the predominant pain and pressure is on the sides of the abdomen; so it must affect prin- cipally the ascending and the descending colon. The urine often con- tains blood; it is sometimes turbid and loam-colored, and has a yellowish sediment. The patient cannot pass urine unless he sits cross-legged, and that, too, though the bladder be full. The cough of Zinc is spasmodic, as if it would draw the chest in pieces. The sputum may be bloody. This is particularly noticed just before or during a menstrual period. It is also aggravated by eating sweet things. You will sometimes find Zincum helping in children, who, every time they cough, put their hands on the genital organs. In its action on the male genital organs Zincum is similar to Conium. It is indicated in spermatorrhoea following long-lasting abuse of the genital organs, with great hypochondriasis. The face is pale and sunken, with blue rings around the eyes. There is great local irrita- tion. The testes are drawn firmly up against the external ring. It differs from Conium in that the latter remedy lacks the excessive irritability. Zincum is also useful in diseases of the female organs, especially for irregularity in the menstrual function, particularly when it is associated with ulceration of the cervix uteri and boring pain in the left ovarian region. All the symptoms improve at the onset of the menstrual flow. • LECTURE LXI. FERRUM AND THE MAGNESIA SALTS. Ferrum Metallicum. f Ipecacuanha, Arsenicum, China, Veratrum alb. ^ Pulsatilla. Ferrum. -{ . v V China. Alumina. Iodine. j Arsen. [_ Cuprum. 1 Puis. Ferrum has two complements, Cinchona or China, and Alumina. Ferrum and Alumina are complementary in chlorosis; and Ferrum and Cinchona in anaemia from loss of animal fluids. Now the best antidote to Iron I know of is Pulsatilla. And, as good fortune will have it, Pulsatilla also antidotes Cinchona, which is so frequently given in combination with Iron by old-school physi- cians. Ferrum acts best in young persons, male or female, who are subject to irregular distributions of blood. The cheeks are flushed a bright red, giving them an appearance of blooming health; and yet this is only a masked plethora. When they are unexcited and quiet they are apt to be pale, and the face has an earthy color. Among the evidences of this irregular distribution of blood we have the following symptoms: Violent hammering headache, which is usually periodical in its return and worse after twelve o'clock at night; nose-bleed, with bright red flushing of the cheeks; the nose is filled with dark, clotted blood during an attack of catarrh; asthma, associated with an orgasm of blood to the chest, and which is worse after twelve o'clock at night, at which time the patient must sit up and uncover the chest. He uncovers the chest to get cool, and sits up in order to breathe. Ferrum is also suited to haemoptysis, especially7 in young boys or girls who are subject to con- sumption and who are just iu the incipient stages of phthisis florida. Almost all these symptoms are excited by any emotion and are accom- panied by great fatigue, despite the appearance of health. Even the neuralgia which Ferrum may cure has fulness of the bloodvessels as a 608 A CLINICAL MATERIA MEDICA. concomitant condition. This neuralgia is excited by washing in cold water, especially after being overheated. The pains are of a throbbing character, and are worse at night. Almost all of these symptoms, both the congestions and the pains, are relieved by slowly walking about. Now, you may understand the action of Ferrum if you remember this one quality of the drug. It has the power of dilating the bloodvessels, probably by diminishing the action of the vaso-motor nerves; hence, you do not find a full, bounding pulse, as under Aconite, but a full, yielding pulse. You will find, when Ferrum is indicated, that the walls of the abdomen are sore, as if bruised. This is due, not to inflamma- tion, but to dilatation of the bloodvessels. This places Ferrum along- side of Gelsemium and separates it from Aconite. We have next to study Ferrum as a chlorotic remedy. We do not use Ferrum, or, at least, we should not, as allopathic physicians do in chloro- sis, because in this disease there is a defective amount of iron in the blood. That is not the homoeopathic principle for giving the drug. The homoeopathic principle is to correct the defective supply of haematin which lies back of the want of iron in the blood. This deficiency is due not to want of iron in the food taken, but to want of power on the part of the system to assimilate it. Therefore, Ferrum is not the rem- edy in chlorosis. It may, however, be indicated in that disease when the following symptoms are present: In the first place, in a general way, it is called for in erethistic chlorosis—that is, chlorosis with erethism of blood. It is usually aggravated during the cold weather, less so, how- ever, than it is during warm weather. The face is ordinarily of a pale, waxen or earthy hue, and subject, at every little emotion, to flush up red. The slightest emotion of pleasure or distress, the sudden entrance of any one into the room, the meeting of a stranger, and, in fact, any- thing that is calculated to disturb the mind, causes flushing up of the face. The cheeks become bright red. Now, this is not a true plethora; it is a masked case. The face is really of an earthy hue, but flushes up on any little emotion. The stomach is always out of order, the patient being subject to gastralgia and heavy pressure in the region of the stomach. With this there is a feeling as if something rolled into the throat and close it like a valve. There is great aversion to meat, and, in fact, to anything that is really nourishing. Food has little or no taste. The patient has frequent spells of nausea, which come as soon as he eats, or periodically at twelve o'clock at night. Here it reminds one of Arsenicum. Mucous membranes are abnormally pale. For instance the vermilion of the lips is exchanged for a simple pale pink. In the FERRUM. 609 case of a male patient the glans penis is shrivelled and white, almost as pale as the prepuce. So, too, the cavity of the mouth and the gums are almost white, showing this bloodlessness. The menses are pro- fuse and consist of watery and lumpy blood, and are attended with labor-like pains in the abdomen. The patient is very inactive; it is with great effort that she can move about. She is relieved by exercise. She is chilly during most of the day, with bright red flushing of the cheeks in the evening. There is palpitation of the heart, with well- marked bellows murmur. The blood-vessels all over the body throb violently. Sometimes the anaemia progresses so far that the patient becomes affected with oedema of the feet. The Ferrum patient is subject to frequent congestive headaches, with pulsating pain in the head, worse usually after midnight. The face is fiery red during the attack, and the feet are cold. It is here very much like Belladonna, but is indicated in a very different class of cases from those calling for that remedy. Such patients always complain of ver- tigo or dizziness, which is worse when they rise suddenly from a lying to a sitting posture. Walking over a bridge or by some running water or riding in a car or carriage also causes this vertigo. These are the cases in which you will find Ferrum to succeed. An English physi- cian has advised that Ferrum be administered after a meal instead of before. He thinks it acts better then. I do not know whether this is so or not. Another use that we may make of Ferrum, arising from its tendency to produce ebullitions of blood, is in phthisis florida. It is indicated in young people who are subject to tuberculosis, here rival- ling the well-known Phosphorus. It is indicated more than Phos- phorus when there is this apparent plethora, with great oppression of the chest from any little exertion. The nostrils dilate and work hard with the efforts to breathe. There is frequent epistaxis or nose-bleed, and also haemoptysis, the blood being bright red and coagulated. The cough is of a dry, teasing character, and is made worse after drinking anything warm. It is usually associated with bruised, sore feeling in the chest, and with dull, aching pain in the occiput. In addition to this erethistic phthisis, we may have Ferr'um indicated later in the case when expectoration is purulent and greenish and has a very bad odor, and is mixed with blood streaks. This reminds me of a salt of Ferrum, Ferrum phosphoricum. This is a remedy which was suggested by Schiissler in all cases of inflamma- tion before exudation has taken place. He bases his prescription on the combined effects of Ferrum and Phosphorus. Ferrum phos. stands 39 6io A CLINICAL MATERIA MEDICA. midway between Aconite and Gelsemium. In fact it develops that stage of inflammation which the pathologists describe as indicated by enlargement of the blood-vessels, with paresis of the vaso-motor nerves. Schiissler proposed Ferrum phos. as a substitute for Aconite. It has been given so many times that I now offer it to you with these qualifications. The indications for Ferrum phos. are these: The pulse is full, round and soft; the inflammation has not yet gone on to ex- udation; the discharge, if it is a mucous surface that is affected, is blood-streaked. In other words, the condition calling for it is sur- charging of the bloodvessels. If a patient with phthisis should take cold, and so become greatly prostrated, and have this blood-streaked expectoration, Ferrum phos. even in the two hundredth potency will quickly quiet the pulmonary congestion. So, too, in the secondary congestion following pneumonia. The right lung, for instance, is in- flamed, when suddenly the left becomes congested. Here Ferrum phos. again acts. Or, again, on a warm summer's day, a child is ex- posed while perspiring, and the perspiration is checked. In conse- quence of this, inflammation of the bowels sets in. The stools are watery and bloody. Here, again, is a case for Ferrum phos. In the beginning of dysentery, Ferrum phos. never does any good if there is tenesmus. Then you will have to give Mercurius or some other remedy. We may use Ferrum metallicum itself in diarrhoea. The stools contain undigested food, and come as soon as the patient attempts to eat. In summer complaint of children or cholera infantum, we find these symptoms recurring quite regularly or periodically just after midnight, when the lienteric stools may be accompanied by periodical vomiting. These symptoms of Ferrum place it with Cinchona and Arsenic in a little group of diarrhoea remedies, and rather in advance of Oleander, this last-named drug being indicated when the lienteric stools occur hours after eating. For instance, the child passes one day that which he had eaten the day before. With Cinchona and Arsenic, the stool appears more after than during eating. Argentum nitricum may also be thought of in these cases of diar- rhoea. It seems as if the child had but one bowel, and that extended from mouth to anus. In uterine haemorrhages, Ferrum is useful when there is a flow of bright red blood, often mixed with coagula, and this is associated with a great deal of flushing. The face, which is ordinarily earthy and sallow, becomes bright red and flushed, breathing becomes rapid and a MAGNESIA CARBONICA. 6ll little labored, just as it is in Ipecac. The pulse itself is very much increased in frequency and in strength. Ferrum in haemorrhages seems to stand between Cinchona and Ipecac. Like Cinchona, it is suited to very much prostrated cases in persons naturally anaemic. It is allied to Ipecac., in the bright red gushing flow of blood and the difficulty of breathing. ipecac suits haemorrhage that conies with a gush. It may be asso- ciated with nausea and it may not, but there is very apt to be loud, hurried breathing. Lastly, Ferrum is indicated in intermitting types of fever, particu- larly after the abuse of quinine. You find during the heat distension of the bloodvessels, particularly about the temples and face, throbbing headache, enlargement of the spleen, and even dropsy. Magnesia Carbonica. f Arsenicum, Phosphorus. Magnesia carb. \ Belladonna, Camphor, Pulsatilla, Merc, Colocynth. ^ Ratanhia, Sepia, Cocculus. >Pulsatilla. > Rheum. > Chamomilla. > Belladonna. Magnesia is much used in one form or another by allopaths as a purgative medicine. When thus abused several results may follow. It may become injurious from its tendency to accumulate in the intes- tines as an incrustation of ammonio-magnesian phosphate, and also from its remoter effects on the nervous system. Its action on the latter is not unlike that of Zinc, and it may be used for similar forms of neu- ralgia. The constipation for which it has been prescribed may be made worse, when Nux vomica will have to be prescribed. Rheum is also to be given for the abuse of Magnesia when diarrhoea, with sour, slimy stool and tenesmus, results. Pulsatilla may be useful in some symptoms. Colocynth is called for in case griping pains result from abuse of Magnesia. Chamomilla is indicated w7hen Magnesia causes neuralgia. Almost all the symptoms of Magnesia carb. seem to centre around the action of the drug on the gastro-intestinal organs. All other symptoms depend upon this action more or less, or else are secondary 6l2 A CLINICAL MATERIA MEDICA. in importance. To describe the Magnesia carb. patient to you, I must say that the drug acts on both adult and child. If the patient is a child, you will find it puny and sickly from defective nutrition, milk is refused, or, if taken, causes pain in the stomach, or is passed undi- gested. The child is subject to frequent griping, colicky pains, which are very much like those of Colocynth. The child draws its limbs up to relieve these abdominal pains. The stools are characteristically sour, green and slimy like scum on a frog pond, (reminding us here of Rheum and Chamomilla), and are preceded by much griping and rumb- ling in the bowels, and have been very aptly compared in appearance to the scum on a frog pond. Sometimes, when the stool is not exactly diarrhoeic, it looks as though there were lumps of tallow in it. In severe cases you will find the child poorly nourished, and its mouth full of aphthous ulcers, which are simply indications of the impoverished state of the system from defective nutrition. With these symptoms you can see how Magnesia carb. may be used for marasmus in children. There are several drugs which are here very similar to Magnesia carb., and it will be well for us to consider them. In the first place, Magnesia carb. is similar to Colocynth, in that it has griping, colicky pains, doubling the child up, but it is distinguished from that remedy by the green, slimy stool. Still greater is the resemblance between Magnesia carb. and Rheum. Here the resemblance lies in the sour, slimy stool. The former is the deeper acting remedy of the two, and if you are in doubt as to which to give, Rheum should precede. I must say that Rheum is a rather treacherous remedy. With the sour, slimy, frothy stools it has griping colic and twitching of the muscles of the face and fingers during sleep. Chamomilla resembles Magnesia carb. in many cases, particularly in diseases of children. In both remedies anxiety and restlessness are prominent. But in Chamomilla there is a yellowish-green stool, look- ing like chopped eggs. Both remedies have relief from moving about, and both have griping pains before stool, and both have irregularity in feeding as a cause of the illness. Magnesia carb. is also similar to Calcarea ostrearum. Both have sour stool, rejection of milk, and imperfect nourishment of the body. Calcarea, however, may readily be distinguished from the other by the sweat on the head, face, and scalp, by the damp and cold feet, and by the enlargement of the abdomen. In marasmus compare Magnesia carb. also with Antimonium crudum, Sulphur, Podophyllum, Sepia, and Natrum carb. MAGNESIA CARBONICA. 613 If the Magnesia carb. patient is an adult, we may have some of the following symptoms to guide us: The gastric and hepatic symptoms predominate. The patient suffers from what has been termed acid dyspepsia. Food, such as cabbage and potatoes, and starchy food generally, are indigestible in such cases. He becomes anxious and warm while eating; so hot can't sleep; yet dreads exposure. Pregnant women may require Magnesia carb. wdien they suffer from toothache, and when the pains are worse at night and force the patient to get up and walk about. There is another remedy which I shall mention in this connection, one which you would hardly think of. Some years ago, it may be twenty, a physician of this city was treating a lady in the first months of pregnancy, who suffered terribly from toothache. He gave her Magnesia carb. and other remedies. Still the pain continued. Dr. Lippe was called in consultation, and he thought of Ratanhia, which has toothache at night, compelling the patient to get up and walk about. You can remember these two remedies then, and you may place them with Chamomilla, which is complementary to Magnesia carb. The menses are usually late and scanty, and they have this pecu- liarity: They flow more at night or on first rising in the morning, even ceasing in the afternoon. The flow is also more profuse between the pains. This is true, whether they be profuse or scanty. In all the Magnesia salts the menstrual flow is dark or black, almost like pitch. Magnesia carb. also has some relation to rheumatism, to affections of the muscles and joints. It is suitable for rheumatism in the right shoulder. It also has rheumatic pains in the limbs, which are worse after a long walk, better from warmth, and worse in bed. Sanguinaria is similar to Magnesia carb., in that it has rheumatism affecting the right deltoid muscle. Several years ago I used Sangui- naria quite a number of times without any effect, and I became so dis- gusted with it that I announced to the class that I did not believe in it. Within a week after that I had two cases promptly cured by it. Nux moschata is indicated in rheumatism affecting the left deltoid. There are two cases of cataract on record as having been cured by Magnesia carb. In one of these the patient was predisposed to head- ache and boils. 614 A CLINICAL MATERIA MEDICA. Magnesia Muriatica. Caulophyllum, Actea racemosa. Chamomilla, Pulsatilla, Mercurius. Magnesia mur. Sulphur) LyCopodium, Sepia. Phosphorus, Ignatia. > Chamomilla. The next remedy of which I shall speak is the Chloride of Magnesia or Magnesia mur. This remedy acts particularly on women and children, especially in hysterical women and in scrofulous children. It is indicated in women who suffer from hysterical paroxysms, with the following symptoms: After dinner the patient is seized with nausea, eructations, trembling and fainting spells. These occur after dinner, because that is the principal meal, and more is eaten then than at other times. The patient is anxious and restless, and is always made worse from mental exertion. The headaches are described as congestive, with sensation as of boiling water in the cranium, or as a frontal numb- ness. The pains are referred to the temples, and seem to be relieved by firm pressure with the hands. They are also better from wrapping the head up warmly. The patient also complains of a sensation as of a ball rising from the stomach into the throat. This is relieved by eructation. This shows that the accumulation of gas in the stomach is the cause of this reflex symptom. She also has bearing down in the uterine region and uterine spasms. The menses are black and pitch- like, and are accompanied by pain in the back when walking, and in the thighs when sitting. She also has leucorrhcea after every stool, or following the uterine spasms. In nearly all these cases in which Mag- nesia mur. is indicated, you will find characteristic constipation, in which the stools are passed with great difficulty, being composed of hard lumps, or they are so dry that they crumble as they pass the anus. If you find that symptom present with the uterine symptoms, you may be sure that Magnesia mur. will help the patient. In other cases we find the liver affected. Magnesia mur. is one of our best remedies for liver disease. The liver is enlarged and the abdomen bloated. There are pains in the liver, which are worse from touch or from lying on the right side. The tongue is large, coated yellow, and takes the imprint of the teeth. You will see at once how this resembles Mercurius, but it is differentiated from that remedy by the characteristic crumbling stool. The feet are often oedematous from interference with the portal circulation, and there are palpitation of the heart and dyspnoea, both of these last-named symptoms being MAGNESIA MURIATICA. 615 reflex symptoms from the hepatic disorder. You will also find this crumbling stool. Frequently we find Magnesia mur. indicated in the enlarged liver of children who are puny in their growth and rachitic. They suffer, too, from skin affections. They have what is known as tinea ciliaris, an eruption which occurs at the roots of the hairs, particularly of the eye- lids. The hairs drop out. A scaly eruption appears around the hairs, the skin ulcerates, and the hairs drop-out. With this tinea there are pimples on the face, and acrid ozaena, with redness and swelling and scali- ness of the nose. With these symptoms there is sweat of the feet. Here we are reminded of Silicea. But the sweat under Silicea is offensive. A general characteristic of Magnesia mur., belonging to either men or women, is palpitation of the heart, which is worse when the patient is quiet, and better from moving about. That symptom has been con- firmed many times. Then there is another symptom which occurs fre- quently in women, and that is inability to pass urine without pressing on the abdominal walls. The analogues of Magnesia mur. must be studied here, or else you will not be able to separate it from similarly acting drugs. We find that in uterine spasms, Caulophyllum and Actea racemosa act like Mag- nesia mur. I must say that I believe Caulophyllum leads the list. I know of no other drug that produces such continued spasmodic condi- tion of the uterus unless it be Secale. Silicea ought to be mentioned as similar to Magnesia mur. in the treatment of scrofulous children. Both remedies have sweating of the feet, enlarged liver, rachitis, and ozaena. The difference lies in this: The Silicea patient has offensive-smelling sweat, both of the feet and of the head. That is one good distinction. There are many others. There is a resemblance between the headaches of the two remedies. Silicea and Magnesia mur. both have headache, relieved by wrapping the head up warmly. Mercurius is similar to Magnesia mur. in liver affections. It is dis- tinguished from the latter by its diarrhoea, with tenesmus, or, more exceptionally, with gray or ashy stool. Also similar to Magnesia mur. is Ptelea, which is useful in congestion of the liver when there is a feeling as of weight and pressure in the right hypochondrium. The liver is found to be enlarged. The patient finds relief by lying on the right side. I may say that the Magnesia salts have been placed with Zinc as remedies acting 011 the nervous system. This fact led Schussler to Magnesia phos. as a nerve tonic. LECTURE LXII. BARYTA CARB , STRONTIANA CARB., AND LITHIUM CARB. Baryta Carbonica. Barium and Strontium are very closely related to each other chemi- cally. Of the elements themselves we have no provings. The carbo- nates of these have, however, been proved, as have also the Muriate and the Sulphate of Baryta. Baryta is somewhat of a poison. There are not many cases of poisoning by it on record, because it is rarely used in domestic practice. Baryta carb. has Antimonium tartaricum as its complement, particu- larly in the complaints of old people. Animals poisoned with Baryta carb. exhibit some irritation of the abdominal organs, resembling great inflammation there, with increased peristaltic action of the bowels. The heart, too, is affected by it, the animal apparently dying from paralysis of the cardiac muscle. This paralysis happens in systole. Its action is here very much like that of Digitalis. So much for^the toxic action of Baryta. In all its symptomatology, we find Baryta adapted to ailments occur- ring at the extremities of life, age and childhood; to old age, when there are mental symptoms and bodily weakness, and to children, when there is in addition, scrofula. The child to whom we may give Baryta effectively is almost an imbecile. He, very unnaturally, shows no de- sire to play; he sits in a corner doing nothing. He cannot remember well, and is slow in learning to talk, to read, and to understand. This slowness in learning to talk does not come from defect in the apparatus of speech—the tongue, for instance—but it is the result of mental weakness. The child is rather emaciated, with the exception of the abdomen, which is large. The face, also, is bloated. He may have a voracious appetite, but food is not appropriated by the system, because of the diseased condition of the mesenteric glands. A case of chronic hydrocephalus in a child improved after the exhibition of Baryta selected by these symptoms. Adults—especially old people— have a rather peculiar aversion to strangers, and shun the approach of any unfamiliar face. They seem to have a fear of the presence of BARYTA CARBONICA. 617 others. They imagine that they are being laughed at. They are easily angered and suffer from cowardice. You all have seen similar symptoms to these in persons of a half-imbecile state of mind from disease, whether in old age or in early life. A peculiar mental symptom of Baryta which I give you on the authority of Dr. Talcott, of Middletown, N. Y., is this: The patient thinks his legs are cut off and that he is walking on his knees. You may use Baryta carb. for old people when they suffer from paralysis, particularly paralysis following apoplexy. Very frequently in old people, the brain shrinks and, as the skull does not yield, there would be a vacuum formed, were it not that an effusion of serum takes place. This is followed by a more or less severe paralysis. You will find, in such cases, that the patient is childish and has loss of memory, trembling of the limbs and well-marked paralysis of the tongue. Baryta carb. is one of the few remedies that cause positive paralysis of the tongue. {Colchicum has loss of sensibility of the tongue.) You will see these paretic symptoms also in children of this half-imbecile char- acter of which I have spoken. The mouth is kept partly open and the saliva runs out freely. The child has a silly, vacant look, showing at once that it is non compos mentis. Baryta is one of the remedies for the apoplexy of drunkards. ( Vide ■ Opium.) Baryta also seems to induce paralysis by causing degeneration of the coats of the bloodvessels, even to the production of aneurisms. Causticum acts similarly to Baryta in paralysis, but the paralysis of this remedy has more contractures or spasms. Secale acts on the bloodvessels; but its symptoms are apt to be associ- ated with burning and numbness; gangrene. Both the Muriate and the Carbonate of Baryta may be used in multiple sclerosis of the brain and spinal cord. This is not an un- common disease in infants and children in whom it may give rise to the idiotic symptoms mentioned above. These same symptoms indicate it in disseminated sclerosis occurring in old people. For the trembling associated with this disease, Hyoscyamus should be thought of. When associated with the symptoms just enumerated, you may use Baryta for non-development of the brain in early childhood. The Chloride of Baryta has been used by old-school physicians for this sclerosis, and with more or less success. The remedy which most resembles Baryta here is Causticum. 6i8 A CLINICAL MATERIA MEDICA. The use of Baryta in catarrhs demands attention. It is one of the best remedies we have for the tendency to tonsillitis, particularly in scrofulous children with dry scurf on the head. Baryta mur. and Baryta carb. cause induration of connective tissue. They control pro- liferation of connective tissue, hence their use in tonsillitis, indurated glands, etc., general symptoms agreeing. Every little exposure to damp or cold weather awakens anew the inflammation of the tonsils. This is not a simple sore throat, a swelling up of the mucous lining of the fauces with trouble in swallowing, but it is an actual inflammation of the tonsils with formation of pus. In these cases, you will find enlargement of the glands in the neck, under the jaw and behind the ear. It is one of our remedies to prevent the return of this catastrophe. It changes the constitutional tendencies of the patient. It is thus more the remedy for the effects of the trouble than for the acute symptoms. The local symptoms for the throat are principally these: The right side of the throat is worse than the left, just as you find under Bella- donna; the throat feels worse from empty swallowing. In the treat- ment of tonsillitis, I frequently use the same prescription that I employ in diphtheria, namely, a gargle of alcohol and water. This seems to remove the accumulation of phlegm from the throat. In tonsillar affections, you may compare the following remedies with B arty a: Calcarea ostrearum, in fat, leuco-phlegmatic children. Calcarea phos., in chronic cases; bones diseased. Ignatia, large tonsils, with small, flat ulcers on them. Hepar, large tonsils, hearing poor, sensation as of fish-bone in throat. Lycopodium, large tonsils, studded with small indurated ulcers. Calcarea iod. is similar to Baryta in some cases with enlarged glands, particularly when there are enlarged tonsils which are filled with little crypts or pockets. Conium is suited to enlarged tonsils without any tendency to suppu- ration. Baryta may also be used in children who, in addition to this tonsil- litis, have post-nasal catarrh. Scabs form in the posterior nares and at the base of the uvula The upper lip and nose are swollen, just as you find in Calcarea, but the mental symptoms are different. Baryta is also called for, for a chronic cough occurring in strumous or scrofulous children with swollen glands and enlarged tonsils. Every little exposure to cold or damp causes headache, backache and diar- BARYTA CARBONICA. 619 rhcea. Here Baryta is similar to Dulcamara. The ears may be in- volved in the catarrhal process; crackling in the ears on swallowing, reverberations in the ear on blowing the nose, sneezing, etc. In catarrh of the middle ear after scarlatina, the late Dr. McClatchey used Baryta. Baryta is sometimes indicated in scrofulous ophthalmia; the pains are relieved by looking downwards. The general symptoms are like those of Calcarea ostrearum. We find Baryta also indicated in old people who have what is known as suffocative catarrh, with orthopnoea. I think you can understand this when you remember the influence of Baryta on the voluntary and involuntary muscular fibres. It paralyzes them. In old people, the chest is very much weakened. They get a catarrh, which is not so severe, but appears suddenly in the night. There is difficulty of breathing and blueness of the face, etc. Baryta carb. is one of the remedies that come in after the failure of Antimonium tartaricum. The patient complains of a sensation as of smoke or pitch in the lungs. Baryta should not be given in catarrhal asthma or asthma with em- physema; but when the disease is of the purely nervous variety, in the aged, w7hen aggravation occurs in wet, warm air. You will see that its aggravations are much like those of Aurum. Amblyopia, in the aged, sometimes calls for Baryta; the patient cannot look long at any object; sparks before the eyes when in the dark. It is also indicated in the headaches of the aged, with aggravation after waking, after meals and near a warm stove; the patient has a stupefied feeling. We also find Baryta carb. of use for the fatty tumors which occasion- ally appear here and there over the body. It is very easy to remove these with the knife. But it is much better to cure them by medicine, if you can do so. In tabes mesenterica, Baryta is indicated when there are present, in addition to the foregoing symptoms, the following: Food, when swallowed, seems to pass over sore spots in the oesophagus. There is always pain in the stomach after the child eats. The stool is sometimes undigested. With this, you find the abdomen hard and swollen, and an offensive sweat on the feet, just as you find in Silicea. Now, there are remedies which may be compared with Baryta in this form of disease. Iodine is similar to Baryta in that it is suitable in torpid cases. The complexions of the patient in the two remedies are 620 A CLINICAL MATERIA MEDICA. different. The Iodine patient has a dark complexion, dark hair and eyes and sallow skin. There is, too, extreme hunger. If you observe the child carefully, you will find it anxious and fretful, until he eats, which relieves him for the time being; and yet he grows thin despite the quantity of food consumed. Then, there is a mental symptom which is almost always present when you find Iodine indicated in tabes mesenterica, and that is intolerable crossness, which is even worse than that belonging to Antimonium crudum. Calcarea phosphorica is indicated in children who are weak-minded, who cannot walk, although they are old enough to do so, who are anxious and restless in their manner and who suffer from defective osseous growth. The bones are thin and brittle. Like Baryta, the Silicea patient suffers from damp changes in the weather. He also has offensive sweat and general emaciation with the exception of the abdomen. The difference between the two remedies lies principally in the mental symptoms. The Silicea child is obstinate and self-willed, and, too, his head is disproportionately large to the size of the body. Lactic acid has copious sweating of the feet, but it is not offensive. For the offensive foot sweat, compare Silicea, Thuja, Nitric acid, Kali carb., Graphites and Carbo veg. Strontiana Carbonica. Strontiana carbonica has a few symptoms that are of importance. It has more effect on the circulation than has its relative, Baryta. We have, as a characteristic, flushes in the face and violent pulsation of the arteries. It may be useful in case of threatening apoplexy with vio- lent congestion of the head, with hot and red face every time the patient walks. Mere exertion increases the circulation upwards towards the head. Some erethism is shown in the chest in some patients. There is a smothering feeling about the heart; they cannot rest; there is a feeling as of a load on the chest. These are the congestive symptoms of the heart, lungs and head which suggest Strontiana carb. The pecu- liarity which will distinguish these symptoms from those of any other remedy is, that with these symptoms, which may occur at the climaxis when flashes of heat are so common, you will find that the head symp- toms are relieved by wrapping the head up warmly, just as you find under Silicea and under Magnesia mur. The patient cannot bear the least draught of air; therefore, despite this congestive tendency, they wrap the head up warmly, though it may cause perspiration. It cer- LITHIUM CARBONICUM. 62 1 tainly does resemble Silicea, in that both remedies have congestion of the head relieved by wrapping the head up warmly. The Silicea con- gestion seems to come up the spine and go into the head. That is not characteristic of Strontiana carb. Another effect that we find caused by Strontiana carb., and one, too, for wdiich it is not often used, is diarrhoea, which is worse at night, and which has this peculiar urgent character: The patient is scarcely off the vessel before he has to return. It is better towards morning at three or four o'clock. Strontiana carb. has a marked action on the bones. It has a particular affinity for the femur, causing swelling and caries of that bone; usually in scrofulous children. This trouble is often associated with the diar- rhoea just described. Strontiana carb. causes an eruption which very much resembles that of sycosis. Hence, it has been given for a sycotic eruption on the face or other parts of the body, and which is moist, and itches and burns. Another peculiarity of the drug, and the last one I care to mention, is its effects in chronic sprains, particularly of the ankle-joint, when both Arnica and Ruta have failed. The long interference with the circulation has produced some oedema about the joint. Lithium Carbonicum. « Lithium carb. has not a very extensive range of action. It is par- ticularly useful in affections of the joints. It does have very much depreciating effect on the vital forces. It is efficacious in rheumatism and, above all, in some forms of gout. In its provings, debility is noticed only in connection with or as a sort of sequel of the joint affection. Of the various organs attacked by Lithium carb•., the most important in the order of their importance are the heart, stomach, kidneys and bladder. The mucous membranes are also affected by the drug. At first they are unduly dry, and this dryness is followed later by thick mucous secretion. The skin does not escape. There appears an erythema, with itching of the skin, which occurs par- ticularly about the joints, and is very annoying. It is particularly noticed along with rheumatism Further than this, Lithium carb. may produce roughness of the skin and an eruption about the face resembling barbers' itch. Studying now the symptoms of the drug with this general action before us, we find confusion of the head; headache on the vertex and 622 A CLINICAL MATERIA MEDICA. on the temples, worse on awaking; the eyes pain as if sore, and diffi- culty in keeping the eyelids open. This vertex headache and soreness of the eyes follows suppression of the menses. The patient has pain from the left temple into the orbit of that side; relieved while eating and worse after eating. A very characteristic symptom of the retina, or rather of vision, is, the right half of objects vanishes. In keeping with its effect on mucous membranes, we find the drug causing conjunctival asthenopia, just as does Alumina. The conjunc- tiva of both lids and eyeball is painfully dry and the eyes feel sore when the patient reads. The nose is affected, too, in the Lithium proving, being swollen and red. Sometimes there is dryness of the nose when in the house, and mucus dropping from it when in the open air; or mucus seems to hang in strings from the posterior nares. Another symptom of Lithium is sensitiveness of the mucous membrane when the inspired air is un- duly cold. Lithium cures a cough which seems to come from a certain spot in the throat. There is a form of gastralgia which Lithium will cure. It is accom- panied by pain in the left temple and orbit, which is better by eating. Lithium has some effect on the bowels. Drinking chocolate or cocoa will cause diarrhoea. Lithium irritates the neck of the bladder. This, you know, is often a symptom of rheumatic patients. The urine is turbid and flocculent. The pains extend down either ureter and into the spermatic cords or testicles, and are followed by red urine with mucous, deposit. In the female, you find Lithium carb. indicated when the menses are late and scanty7. The provers found that all the symptoms accompany- ing the irregularity in menstruation were on the left side. Now, we will consider the rheumatic symptoms of Lithium carb., including under this head those of the heart also. I have succeeded, in several instances, in relieving chronic rheumatic patients by this remedy. The symptoms which indicate the drug are these: Rheu- matic soreness about the heart; valvular deposits will be found in many instances; mental agitation causes fluttering of the heart; very marked is the pain in the heart when the patient bends forwards; the cardiac muscle is evidently irritated, for we find shocks or jerks about the heart; the cardiac pains are relieved when the patient urinates. LITHIUM CARBONICUM. 623 Now, the symptoms of the body, joints and limbs: Tenderness, with swelling and occasional redness of the last joints of the fingers; clumsi- ness in walking from unwieldiness of the muscles; intense itching on the sides of the feet and hands without any apparent cause. The pains in the joints are usually worse in the knee-, ankle- and finger-joints. The whole body feels stiff and sore as if beaten. Pains go down the limbs. The whole body increases in weight and becomes puffy. I may say that this puffiness is not due to a healthy fat, but is a flabby condi- tion which belongs to all the alkalies. Gettysburg spring water, which contains carbonate of lithia, is very efficacious in scrofulous children when there are ulcers about the joints, as in Pott's disease and hip-joint disease, when there are offensive pus and diarrhoea. This character of the catarrh of Lithium carb. in which the inspired air feels cold is also found under Kali bichr. and Corallium rubrum. Kali bichromicum, Sepia and Teucrium have catarrh, with expecto- ration of solid chunks from the posterior nares. In vulvular deposits in the heart you may compare Lithium carb. with Ledum, Kalmia and Benzoic add, the latter remedy being selected by the offensive character of the urine. Zincum, Conium and Aurum have sudden jerks or shocks about the heart. In rheumatism and gout you may compare Kalmia and Calcarea ostrearum, which resemble Lithium in the rheumatism of the finger- joints. When there are nodular swellings in the joints, compare Calcarea ostrearum, Benzoic acid, Lycopodium and Ammonium phos. LECTURE LXIII. THE AMMONIUM PREPARATIONS. Ammonium caust. Ammonium carb. Ammonium phos. Ammonium mur. Blood.— Scorbutus. Uraemia. Carbonized blood. Heart. Mucous membranes.— Nose. Throat and larynx. Lungs. Skin.— Erythema. Scarlatina. Organs. We have on the board to-day several of the salts of ammonia, the Carbonate of Ammonia or Ammonium carb., Caustic Ammonia or Ammonium causticum, Muriate of Ammonia or Ammonium muriaticum and Phosphate of Ammonia or Ammonium phosphoricum. The am- monium salts taken as a class, we find best suited to rather fat and bloated persons. Ammonium carb. is particularly indicated in fat flabby individuals of indolent disposition who lead a sedentary life. This is very different from Nux vomica and Sulphur both of which are indicated in complaints arising from sedentary habits. But Ammonium carb. is especially indicated in fat lazy individuals. Ammonium mur. is best indicated for fat sluggish individuals par- ticularly when the adipose tissue is mostly distributed over the trunk, the legs being disproportionately thin. That is the distinction that may be made between the Carbonate and the Muriate. The salts of ammonium exert a considerable influence over the blood. Thus if Ammonium carb. is taken for awhile there will be produced symptoms simulating those of scurvy. There will be haem- orrhages from the mouth, nose and bowels, showing you that there is a disintegration of the blood. The muscles become soft and flabby and there-is well-marked tendency to emaciation. AMMONIUM CARBONICUM. 625 We find that all the salts of ammonium act powerfully on the mu- cous membranes, of which tissue every one of them produces inflamma- tion. This inflammation is of a violent character, starting with a sim- ple feeling of burning and rawness, progressing to a complete inflamma- tion of the mucous membrane and ending in the destruction of the epi- thelium, which peels off in layers and leaves a raw, burning ulcerated surface. It is, then, not to be wondered at, that the salts of ammonia have won considerable praise in affections of the nose, throat, and larynx, and somewhat of the lungs. The ammonium salts also have an impression on the skin. When applied locally there is produced a simple erythema followed by der- matitis and some little swelling. Soon, however, an eruption appears, and this varies with the different ammonium salts. It is at first pap- ular, then vesicular and finally advancing to ulceration. These condi- tions are common to all the ammonium preparations of which we have any knowledge. Therapeutically, the salts of ammonia are antagonized by Veratrum viride, Digitalis, Aconite, cold and other cardiac sedatives. Their action is favored by heat, Opium, Iodine, Valerian, Asafoslida, Alcohol, etc. Ammonium Carbonicum. Arnica, Antimonium tart. , Belladonna, Apis, Lachesis. Ammonium carb. < . . . _ , „ Arsenicum, Aurum, Carbo veg., Curare. I Conium, Senega, Kali bi., Calcarea ostr. ^ ( Camphor. I Arnica. Nitri sp. dulc. > Arsenicum. > Phosphorus. To-day we begin our study of Natrum muriaticum or common table-salt. This has always been held up to us as an opprobrium against medicine, and as a confirmation of the fallacies of Homoe- opathy. A physician once said tome: "What! will you use a sub- stance which is used iu almost every food and call it a medicine, and say that you obtain good effects from it?" I can assure you, gentle- men, as I assured him, that Natrum mur. is a medicine, and I can •assure you, too, that that very man afterwards became a warm advo- cate of the medicinal virtues of Natrum muriaticum. I tell you that when you potentize a drug you will find that you1 no longer have to depend upon the ordinary laws of dietetics, hygiene or chemistry, but you step into a realm which is distinct from the laws of chemistry and of physics. Medicines are then no longer subject to the coarser laws. Natrum mur. was re-proved by the Austrian provers, a company of physicians who made heroic provings of some drugs, some of them dying from the effects of their provings, so large and powerful were the doses of the medicines they took. One of the provers, whose name I have forgotten, said, when he published his provings of Natrum mur., that the higher potencies of the drug produced the most symptoms, and these symptoms, moreover, were more valuable than those pro- duced by the low. It is true of Natrum mur. as of most other drugs, that the high potencies act best. You will notice on the board that I have placed Argentum nitricum and Apis as complementary to Natrum mur. Argentum nitricum 66o A CLINICAL MATERIA MEDICA. holds a complementary relation to Natrum mur.. It also, at times, antidotes. Ii acts as a chemical or as a dynamic antidote according to the quantity of the drug taken. The relation between Apis and Natrum mur. is particularly evident in the treatment of chills and fever, and skin affections. Salt is one of the substances used to antidote the poisonous effects of bee-stings. When Natrum mur. has been abused as a condiment, Sweet spirits of nitre may be used as a successful antidote. Some other effects of Natrum mur. are antidoted by Arsenicum, and still others by Phos- phorus. I do not now recall any remedy inimical to Natrum mur. Natrum muriaticum or Chloride of Sodium may be considered first in its physiological relations, so that we may learn something of its value as a medicine. It enters into every tissue of the body, even into the enamel of the teeth. Speaking now physiologically, it is regarded as a stimulant to the various tissues into which it enters. It exists in quite considerable quantities in the various humors of the eye, par- ticularly in the aqueous humor and crystalline lens, and also in the vitreous humor. It has been said that its function here is to preserve the transparency of the respective tissues. Virchow, in his Pathology} I quotes an authority who gave Chloride of Sodium to dogs until he pro- i duced opacity of the crystalline lens. Hence, cataract may be pro- \ duced by Natrum mur. Chloride of Sodium in the stomach stimulates digestion and this, too, within the bounds of physiology. It stimulates digestion in various ways. First, it promotes the flavor of food. We all know how insipid certain articles of diet are unless salted. We know from physiology that if a substance has its taste enhanced, its digestibility is also in- creased. That which is agreeable, digests more readily than that which is unsavory. Salt also acts on the stomach itself by favoring the secretion of gastric juice. Salt acts on the glands producing an in- crease in the glandular secretions. Thus we find it acting on the sudorific glands and also on the mucous glands. Schussler argues that salt is excreted through the mucus. That is true. Therefore he says that as salt has a function here, it must be the remedy for all catarrhs. That is too sweeping a conclusion for so limited a premise. It is true that if you examine healthy mucus you will find that it contains considerable salt. It is true also that Chloride of Sodium produces an excessive flow of normally consti- tuted mucus. From this you may take a useful hint. Wherever you find a catarrh with a copious secretion of clear normal mucus, there NATRUM MURIATICUM. 66l Natrum mur. can come in as a remedy. We find it acting also on the sebaceous glands. These little glands are quite numerous in cer- tain parts of the body, particularly around the wings of the nose and the cheeks. Their function is to lubricate the skin. Natrum mur. stimulates these. The skin becomes oily in appearance. We notice this particularly in the face, in the scalp, and more than likely, in other parts of the body. Salt also has a stimulating effect on the nervous system, keeping up its tone. Muscular tone is also favored by the presence of salt within the tissues of the muscles. This brings me to hint to you that common salt may be used as an external .application in weaknesses of the muscles and nerves that favor deformities of the limbs. When you first notice that a child is walking on the side of its feet, or when you meet with a case of post-diphtheritic paralysis, you may use friction with salt to great advantage. I do not mean to say that it will cure all deformities, for some arise from inflammation of the anterior gray cornua of the cord. Chloride of Sodium cannot cure then, for this trouble is due to organic disease. /""^ Again, we may frequently use salt in the form of the sitz-bath for / obstinate amenorrhcea. i_____________ We shall frequently find Natrum mur. indicated when the blood is impoverished. The nutrition of the whole system, therefore, suffers. We find it indicated in anaemia, particularly in anaemia provoked by loss of fluids, hence often with women who suffer from menstrual dis- ease and with men who suffer from loss of semen. We shall often find it indicated in scorbutic states of the system when the patient suffers more or less from scurvy. It is quite likely that the prolonged use of salt meat is a common cause of scurvy. In these cases the mouth becomes sore, ulcers form on the tongue and on the gums, and the breath has a foetid odor. The tongue presents a mapped appearance.jj This symptom we find in other remedies, as Arsenicum, Rhus tox. I Kali bichromicum and Taraxacum. Again, as a result of this impoverishment of the blood, we find the nervous system suffering secondarily. Natrum mur. may be given for the following symptomatic indica- tions: The patient is emaciated, and this emaciation is very marked. The skin is rather harsh and dry and of a yellowish hue.^ The patient feels greatly exhausted from any little exertion of mind or body. On account of the anaemia we have the circulation readily excited, so that every little exertion produces throbbing all over the body. The pa- 662 A CLINICAL MATERIA MEDICA. tient suffers frequently from palpitation of the heart, and this, too, is excited by every emotion. It is often described by the patient as a sensation as though a bird's wing were fluttering in the left chest. Mentally, we find these patients sad and tearful. You^will seldom find Natrum mur.. indicated in chronic affections unless there is tjiis, low-spirited condition of the mind. The patient seems to be made worse by any attempt at condolence. Consolation may even make her angry. This tearful condition is accompanied by palpitation of the heart and intermittent pulse. Now, this intermittent pulse does not necessarily imply organic disease of the heart, but simply a nervously weak heart. At other times you will find the patient decidedly hypochondriacal, just as we have already found with Natrum carb. . This hypochondri- asis is directly associated with indigestion, as in Natrum carb. But there is this difference: With Natrum mur., the remedy under consider- tion, this hypochondriasis keeps step with the degree of constipation, not alone with the indigestion, as in the other. In addition to this melancholy mood we also have irritability devel- oped by Natrum mur. The patient becomes angry at every little trifle. He stores up in his mind every little real or imaginary offence. He wakes up at night with palpitation of the heart and cannot go to sleep again, because past unpleasant events occupy his mind. Intellectual ability is impaired. He becomes disinclined for mental work; makes mistakes, as if confused; loss of memory; study aggra- vates. Frequently school girls suffer from headache, as if little ham- mers were pounding the head, whenever they study. Excitable, laughs immoderately at something not ludicrous; fingers move involuntarily, as in chorea; trembling of the limbs; muscular jerks; awkward; she \ drops things. Now add to these chronic symptoms the following, and you have a complete picture of Natrum mur. Excitement is always followed by melancholy, anxiety, fluttering at the heart, limbs go to sleep, with "crawling" even in the lips and tongue; limbs heavy, espe- , daily in anaemic girls, whose faces are yellow, skin dry and shriveled, and menses scanty or checked. Mental emotions cause such weakness \ that one or more limbs are useless. ^-^ While on this subject of the nerves we may as well add the remain- ing symptoms: Spinal irritation; backache relieved by lying on some- thing hard; small of back pains, as if broken; paralyzed feeling in lumbar region, worse in the morning after rising; tongue stiff, clumsy speech; joints weak, especially the ankles, worse in the mornings. NATRUM MURIATICUM. 663 This last symptom accompanied by imperfect nutrition, grows thin in spite of good appetite, has led to the successful topical and internal use of salt in children with weak ankles; the feet turn under while walking. Now, in mental symptoms, Natrum mur. runs against several drugs. One of these is Pulsatilla, which is the most lachrymose remedy of our materia medica. But Pulsatilla has rather a tender, yielding disposi- tion, that likes consolation. The more you console her the better she likes it. Sepia is more similar to Natrum mur. than is Pulsatilla, in that both remedies have this low-spiritedness and vehement angry disposition combined. Both have Indian-like hatred of those who have injured them. In fact, these remedies are complementary to each other. The Sepia patient, however, has marked indifference to her household affairs. ~~ The patients who suffer from these mental symptoms calling for Natrum mur. are generally chlorotic They suffer from leucocythaemia. The menses are often late and scanty, or else cease altogether. When the menses have not entirely ceased and are scanty they are accompa- nied by such marked symptoms as these: Decided increase of the.sad-.. ness before menses; palpitation of heart, which, too, is apt to be of this fluttering variety, and throbbing headache, which headache continues persistently after the menstrual period. The Natrum mur. patient fre- quently suffers too from uterine displacements. She has quite charac- teristically prolapsus uteri, which is particularly induced when she gets up in the morning. The symptom reads, '' When she gets up in the morning, she must sit down to prevent prolapsus." This is a func- tional disease altogether. There is no organic change in the uterus, but there is great relaxation in the ligaments which support that organ. As she arises in the morning, relaxed instead of refreshed after her night's sleep, the uterus falls and she has to sit down to pre- vent this dragging. You will find these uterine symptoms accompa- nied by backache and decided spinal irritation, which is greatly relieved by lying flat on the back or by pressing a pillow firmly against the back. That I have confirmed over and over again for Natrum mur. In addition, you will have a characteristic symptom of the bladder that is just as often present as is the prolapsus itself, ' and that is, cutting in the urethra after urination. That symptom, I have seen successfully applied many times. Backache and morning aggravation are symptoms which will aid you in the selection of Na- trum mur. 664 A CLINICAL MATERIA MEDICA. Natrum mur. produces a headache, worse from any use of the mind. In the morning on awaking, there is throbbing, mostly in the fore- head, as if from many little hammers beating in the head. This, too, is worse from any use of the mind. The pain is so severe at times as to make the patient almost maniacal. With this kind of headache, the tongue is dry and almost clings to the roof of the mouth, although it may look moist when put out. There is great thirst. The pulse is almost always intermittent. This helps you to distinguish it from its complement, Sepia, which has a similar symptom. I do not want you to forget that sharp headache of Sepia, that sharp pain in the lower part of the brain, apparently in the meninges, shooting upwards. The patient can bear neither light nor noise. The pain is usually attended with nausea and vomiting as a secondary symptom. Natrum mur. also produces a headache simulating that of Bryonia; sharp stitching about the head and sore bruised feeling_ about the eye- balls, especially when the eyes are moved. I may say that these heacP aches of Natrum mur. are particularly common in school children at the age of ten or eleven. Calcarea ostrearum is also a good remedy here. You may have occasion to use Natrum mur. in ciliary neuralgia, especially when the pains are periodical, returning from sunrise to sunset, being worse at mid-day. Spigelia is a drug which also has headache or ciliary neuralgia, coining and going with the sun and worse at mid-day. Gelsemium and Glonoin have not so much neuralgia as throbbing in the head, which grows worse and worse with the sun. Natrum mur. also causes headache with partial blindness; here it resembles Kali bichromicum, Iris and Causticum. Natrum mur. has a very powerful influence on the various portions of the eyes. Now, all over the body, the drug produces weakness of the muscles. This is especially manifest in the muscles of the eyes. The muscles of the lids feel stiff when moving them. Letters blur and run together when looking steadily at them, as in reading. You see that there is marked asthenopia. Natrum mur. is especially indicated when the internal recti muscles are affected. These asthenopic symp- toms depend upon a general break-down. The spine is weak and irritated, digestion is slow and imperfect, and nutrition is not as rapid or as complete as it should be. Another form of eye disease in which Natrum mur. is indicated, is scrofulous ophthalmia. You will be called upon to use the drug in NATRUM MURIATICUM. 665 such cases when nitrate of silver has been abused. There are smart- ing and burning pains and a feeling as of sand beneath the lids. The tears are acrid and there is very marked spasmodic closure of the eye- lids. You can hardly force the lids apart. Ulcers form on the cornea. The eyelids themselves are inflamed and agglutinated in the morning. In addition to these eye symptoms, these scrofulous children suffer from eruptions particularly marked at the border of the hair. Scabs form on the scalp and from these there oozes a corrosive matter. There are moist scabs in the angles of the lips and wings of the nose, and with these, emaciation. In scrofulous ophthalmia you should compare with Natrum mur., Argentum nitricum, Arsenicum and Graphites. For scabs in the corners of the mouth and wings of the nose, com- pare Antimomiurn crudum, Graphites and Causticum. Natrum mur. also causes half-sight. Here you should compare Aurum, Lithium carb., Lycopodium and Titanium. Natrum mur. acts on the mucous membranes. We find it indicated in catarrhs with mucous secretion abnormal in quantity rather than in quality. This hypersecretion of mucus is accompained by paroxysms of sneezing. Fluent alternates with dry coryza. Every exposure to fresh air gives the patient cold. The wings of the nose are apt to be sore and sensitive. There is almost always in the Natrum mur. catarrh, loss of smell. Natrum mur. is one of the best remedies for hawking of mucus from the throat in the morning, when the symptoms call for no other remedy. The tonsils are often very red. The uvula is elongated, probably from relaxation of its muscles. There is a constant feeling as of a plug in the throat. The patient chokes easily when swallowing. The tongue is coated in insular patches. The cough arises from the accumulation of clear mucus in the poste- rior nares, pharynx and larynx. Of course, there is hoarseness. Another form of cough calling for Natrum mur., is cough arising from tickling in the throat or at the pit of the stomach. This kind of cough is accompanied by bursting headache, here reminding one of Bryonia, and sometimes, by involuntary spurting of urine, as we find under Scilla f>> i. '.<■ ~j and Causticum, and often, too, by stitches in the liver. Natrum mur. has marked action on the male genital organs. It causes great weakness of these, giving rise to seminal emissions during sleep. These are followed by debility and great weakness. The geni- tal organs are greatly relaxed. Wet dreams may even occur after 666 A CLINICAL MATERIA MEDICA. coitus. That may seem to you an anomalous symptom, but it is not. During the act of coitus, erections are not strong and the ejaculation of semen is weak or even absent. The consequence is, there is not an entire emptying of the seminal vesicles. There is still irritation re- maining there. When the man goes to sleep, this irritation, by reflex action, excites lascivious dreams. As consequences of the excessive seminal loss, we find backache, night-sweat, weakness of the legs and the melancholy which is characteristic of the remedy. Natrum mur. is not alone among the soda salts in this class of ailments. Natrum phos. was proved by gentlemen in this college. They had seminal emissions every night. At first, there seemed to be erethism with lascivious dreams, but later, emissions took place, one or two in a night, without any sensation whatever. These were followed by weakness of the back and by trembling of the knees, which felt as though they would give way. You will find, too, that gonorrhoea is curable by Natrum mur., espe- cially when chronic. The discharge is usually clear (it may be some- times yellowish). There is well-marked cutting in the urethra after urination. It is especially indicated in cases that have been abused by the nitrate of silver. Nutrition is greatly impaired under Natrum mur. as I have already told you. Emaciation is marked in almost every case in which it is the similimum. We may make use of this fact in children who suffer from marasmus from defective nourishment. They are thin, particu- larly about the neck.* They have a ravenous appetite and, despite this, they grow thin, at least they do not grow fat. Here you find it comparable with Iodine, but the peculiar emaciation of the neck, dis- proportionate to that of the body, is sufficient to distinguish it from that drug. In addition to this, you may have, at times, well-marked thirst. The child craves water all the time. This is what the laity term inward fever. There is constant heat and dryness of the mouth and throat, which the water relieves. If there is constipation when Natrum mur. is the remedy, there is a very characteristic stool, hard, difficult to expel, Assuring the anus and, as a consequence, there is bleeding with the stool. Of course, smarting and soreness is the result of this laceration of the anus. Natrum mur., like the other salts of soda, is a first-class remedy in the treatment of dyspepsia. We find it indicated when farinaceous * Veratrum album has emaciation about the neck, especially in whooping-cough. NATRUM MURIATICUM. 667 food, particularly bread, disagrees. The symptom reads, "He is averse to bread of which he was once fond." On the other hand, there is crav- ing for oysters, fish and salty food or for bitter things. After eating, the patient is very thirsty. There is a distressed indescribable feeling at the pit of the stomach. This is relieved by tightening the clothing, just the opposite to Lachesis and Hepar; and precisely the same as Fluoric add. The constipation, which I have described, causes hypo- chondriasis. The patient is low-spirited and ill-humored, and this mental condition seems to keep pace with the degree of constipation. When the bowels are moved, the mind is relieved. You must use this symptom rationally. Those who have been accustomed to taking pur- gative medicines will almost always feel badly if their bowels remain costive longer than the usual time. They have dull headache, nasty taste in the mouth, etc., and when the bowels move, they feel better. Here, Nux vomica is the remedy. It is not often that undisturbed con- stipation produces this condition of mind, but when it does, Natrum mur. is the remedy. The rectum suffers from tenesmus with slimy discharge as in chronic proctitis. Prolapsus ani with discharge of bloody mucus and water, and burning preventing sleep; dryness and smarting of rectum and anus, with tendency to erosions of the mucous membrane. Sensation of a rough substance in the rectum and yet bowels are loose.* Con- striction of the anus, faeces hard and evacuated with such exertion as to tear the anus. Chronic watery diarrhoea with dry mouth, secondary to dry stool.f We find Natrum mur. indicated in affections of the coarser tissues, for instance, of the skin. I have already told you how it affects the sebaceous glands. We find that it produces urticaria. The itching is very annoying. It occurs about the joints, particularly about the ankles. Wheals form on different parts of the body and these itch, smart and burn. Especially do we find Natrum mur. indicated when these symptoms accompany intermittent fever, or occur after exposure to damp cold, especially at the seaside. Exercise makes this nettle-rash intolerably worse. Just here, we find Natrum mur. complementary to Apis. * Compare Sepia, which has lump in rectum: Atsculus and Collinsonia, that have sensations as of splinters or sticks in the rectum. | This dry state resembles Alumina, Graphites, Magnesia mur., Ratanhia, ASsculus, etc. Graphites has mucus-coated stools ; Alum, has smarting soreness; Magnesia mur., crumbling stools ; Ratanhia. feeling of splinters of glass; fissures- 668 A CLINICAL MATERIA MEDICA. Apis is an excellent remedy in the treatment of urticaria, but it is not so good, I have found, in the treatment of the chronic form of the disease. Here we have to use other drugs, as Natrum miir., and above all, Calcarea ostrearum. There is another form of eruption yet to be thought of for Natrum mur., and that is herpetic eruptions. Thus, we find particularly char- acteristic of Natrum mur., what are called hydroa-labialis. They are little blisters which form on the borders of the lips and wdiich accom- pany every marked case of chills and fever indicating Natrum mur. They are akin to what are commonly known as fever blisters. Hepar, Natrum mur. and Rhus tox. are the remedies which have this symp- tom most marked. Arsenicum also has u;. In the very beginning of these cold sores, the application of camphor will stop the trouble. If, however, they are well advanced, Hepar relieves them and prevents their return. Camphor is not a curative remedy, but Hepar is. Herpes circinatus, a variety of ring-worm, calls for Natrum mur. Other remedies for this trouble are Sepia, Baryta carb. and Tellurium. Another form of eruption calling for Natrum mur. is eczema, which appears in thick scabs, oozing pus, and matting the hair together, a crusta lactea in fact. Lastly, I come to speak of the well-known application of Natrum mur. to intermittent fever. There it shares the honors long accorded to Cinchona and Arsenic Natrum mur. is to be considered when the chill comes characteristically between ten and eleven a. m. The chill begins in the small of the back or in the feet. It is accompanied sometimes by thirst, and by aching pains all over the body. Some- times urticaria complicates the case. Fever is usually violent. Thirst increases with the heat. The headache becomes more and more throb- bing. So severe is this cerebral congestion at times that the patient becomes delirious. By and by, sweat breaks out quite copiously and it relieves the headache and also the other symptoms. This is the chill curable by Natrum mur. When chill occurs at 10 a. m., as a result of hectic fever or phthisis, Stannum is to be used and not Natrum mur. LECTURE LXVIII. BORAX VENETA. ( Staphisagria, Mercurius. Borax. J Sepia, Pulsatilla. t Bryonia. >Chamomilla, Coffea. \ Vinegar. / Wine. Borax is the biborate of soda. As a medicine, it won its first laurel in the nursery, where it has long been used in the treatment of sore nipples and children's sore mouth. Like all popular remedies, it has been greatly abused. Homoeopathy has rescued it from the nursery and now offers it to the profession as a medicine of great value, telling when it may and when it may not be used. Underlying this sore mouth, which seems to be the keynote for the use of Borax, is a system or constitution which will permit of the sore mouth, that is, an illy- nourished system. Thus the infant becomes pale or of an earthy hue, its flesh grows soft and flabby; it cries a great deal when it nurses, screams out during sleep and awakens clinging to its mother as if frightened by a dream. The child is excessively nervous, so much so that the slightest noise, the mere rustling of paper, or a distant heavy noise, will arouse and frighten it. This nervous excitability qualifies the pains. For instance, in the earache, you will find that each paroxysm of pain causes the child to start nervously. This earache is accompanied by soreness, swelling and heat of the ear, just as you find in Belladonna, Pulsatilla and Chamomilla. There is a mucous or muco-purulent otorrhcea. Borax is distinguished from these similar remedies by this character of the nervousness, this starting with the pain or with slight noises, by the paleness of the face and above all by another well-proved symptom, the child dreads a downward motion. Thus if the little one is soundly asleep in its mother's arms and she makes the attempt to lay it down in its crib, it gives a start and awakens. If she attempts to carry it down stairs, it will cling to her as if afraid of falling. This must not be confounded with the excita- 670 A CLINICAL MATERIA MEDICA. bility of other medicines, as Chamomilla and Belladomia. It is not the motion that awakens the child. The child will not awaken if it is moved without any downward motion. It must, then, be the down- ward motion that arouses it. The reason for this is, that the child is suffering from cerebral anaemia and this downward motion causes a feeling as though it were going to fall. This symptom may also be utilized in adults, as, for example, in the case of invalids who have been ordered to take horseback rides, but who cannot do so, because when the horse lets them down, they feel as if they were in torture. You will also find that ladies, after some exhausting disease, cannot use a rocking-chair, because when they rock backwards, they feel as if they would tumble. The digestion in the Borax case is impaired, as you might infer from the defective nutrition. Colic precedes the diarrhoea in the child I am describing. The stools are usually green, or they may be soft and yellow, but they always contain mucus. Here you have another illus- tration of the affinity of Borax for mucous membranes. Aphthous inflammation of the mouth appears as a concomitant of the diarrhoea. Aphthae form in the pouches on the inside of the cheeks, on the tongue and in the fauces. The mouth is hot, wdiich the mother notices when the child takes hold of the nipple. The mucous membrane around these aphthae bleeds easily. The child lets go of the nipple and cries with pain and vexation, or else refuses the breast altogether. Similar to Borax are the following remedies: First, Bryonia; this remedy has caused and has cured infants' sore-mouth. But the char- acteristic symptom in Bryo7iia is this: The child refuses to nurse or makes a great fuss about it, but so soon as its mouth is moistened, it takes hold of the nipple and nurses energetically. Is not this in keep- ing with the character of Bryonia ? Those of you who know anything of that drug will remember how dry the mouth is, and how devoid of secretion is the mucous tract. Hence, when the mucous membrane of the mouth is moistened the child nurses at once. Mercurius comes in as a substitute for the Borax when, with the sore mouth, there is very often salivation. Water dribbles from the child's mouth. The diarrhoea is accompanied by well-marked tenesmus. These are sufficient distinctions between Mercury and Borax. Again, you must remember a forgotten remedy, and that is AEthusa cynapium, or the fool's parsley. This is to be preferred when the colic and crying are accompanied by the violent vomiting characteristic of this drug. BORAX. 671 Another remedy is Arum triphyllum. This is readily distinguished from Borax by the violence of the symptoms. The inflammation of the mouth is exceedingly violent and is accompanied by soreness and scabs around the mouth and nostrils. Another common baby symptom in the Borax case is that the infant screams before urinating. The urine when passed is hot and has a peculiar pungent foetid odor. Now this is not to be confounded with gravel, which is not uncommon in little children, and which will call for Sarsaparilla, Lycopodium, Benzoic acid, etc; but it is the equiva- lent of the inflammations of other mucous membranes, so that it com- pares with Aconite, Cantharis and another excellent baby medicine, Petroselinum. Do not forget this last-named drug. It is not generally mentioned in our materia medicas, yet it is an excellent remedy. You should give Petroselinum for conditions very similar to those calling for Borax when there is sudden violent urging to urinate. It may be indicated even in gonorrhoea when this sudden urging is present. Passing from child to adult, we find that although the aphthous condition is still master, we still have many of the other symptoms of Borax, the same difficulty in digesting food, the same weakness, and the mucous membranes still the point of attack. We find, for instance, the conjunctiva, particularly the palpebral portion, affected by Borax, giving you soreness especially marked along the borders of the lids. The eyelashes grow inwards instead of outwards and irritate the eye- ball. You should remember it as a remedy which will sometimes help in trichiasis or "wild hairs," and here you should compare it with Graphites. The nostrils ulcerate in the Borax case, causing a great deal of sore- ness, pain and swelling of the tip of the nose. On the mucous membrane of the throat we find Borax having an action, being indicated, like all the soda salts, for accumulation of mucus there. But under Borax, this mucus is tough and difficult of detachment. The leucorrhcea of Borax is clear, copious and albuminous. Like all the other secretions of Borax, this, too, has an unnatural warmth or heat to it. The action of Borax on the lungs must not be forgotten. We find it indicated when there is cough which is accompanied by sharp stick- ing pain, worse through the upper part of the right chest. So sharp are these pains that they make the patient catch his breath. The ex- pectoration has a sort of musty, mouldy odor. You can often use 4 672 A CLINICAL MATERIA MEDICA. Borax in lung troubles and even in phthisis when these symptoms are present. Lastly, we have to mention a few symptoms of the skin. The skin is unhealthy; every little cut or scratch suppurates readily. There is itching of the skin, particularly on the backs of the fingers, here being something akin to the dorsal eczema of Natrum carb. Little ulcers form about the joints of the fingers. The best remedy we have for these small ulcers about the joints is Sepia. Lastly, Borax has been used in erysipelas of the face, particularly of the cheeks. The distinctive character of the drug is a feeling as though there were cobwebs on the face. I would advise you to caution your nurses, if you can do so, not to use powdered borax every time the child has a sore mouth. It may do harm if it is not indicated. I think that I have noticed after this use of the drug that the bowels suffer and the child grows paler and dwindles rapidly, which it did not do before the meddlesomeness of the nurse. LECTURE LXIX. SALTS OF POTASH. Toxicologically, potash may be of some interest to you when, by accident, caustic potash is swallowed. Its great affinity for water makes it attack the tissues with great avidity, producing very deep escharotic effects. It has more power to penetrate the tissues than have some of the other caustics, nitrate of silver for instance; hence, it has been selected as the caustic for use when it is desired to reach far into the parenchyma of a part, as in the treatment of carbuncle; when a large portion of tissue has become gangrenous and a slough must be pro- duced, caustic potash is used. The tissues thus acted upon have a greasy appearance, which is due to the formation of a soap made from the combination of the fats with the potash. Thus it differs materially in its action from the mineral acids, which make the tissues dry and dark, almost like a mass of tinder. When swallowed by accident, for it is seldom used for suicidal pur- poses, the effects of caustic potash are violent. It causes such violent contraction of the stomach that what little of it gets that far is imme- diately ejected by violent vomiting. If the amount of caustic taken is sufficient, it causes a brownish film over the mucous membrane, or there may be spots here and there in the mouth and throat which are denuded of their epithelium. The inflammatory process may increase to such an extent that these spots ulcerate, and as they heal they form cicatricial tissue with the subsequent unfortunate contraction and stricture of the part. The antidotal treatment to such accidents is both chemical and mechanical; chemical, to relieve the effect of the drug, and mechanical, to relieve the trouble that remains. Vinegar, lemon-juice and large draughts of mucilaginous drinks are mostly relied upon to relieve the acute symptoms of this poisoning. But there are many cases of slow poisoning with the potash salts, particularly when our allopathic friends use bromide of potassium so extensively. We, therefore, have the chronic effects of this to treat. These may require to antidote them: Hepar, which is an antidote to 43 674 A CLINICAL MATERIA MEDICA. the metals in general; Sulphur, and other remedies may be called for according to the symptoms present. It has been determined by experiments on mammals, that potash, particularly the carbonate, acts paralyzingly on the muscles. This accounts for the general weakness which belongs to all potash pre- parations. This paralyzing effect is very manifest in the case of the heart muscle, which becomes early affected in poisoning with potash, the animal eventually dying with the heart in diastole, that is, the heart is widely dilated at the moment it ceases to beat. With this hint, you would expect to find potash salts of use in great muscular weakness, in what has been termed paresis, such exhaustion as accom- panies convalescence from protracted disease as typhoid fever. We have it on the authority of Dr. Hering, that mushrooms contain a large percentage of potash, and are therefore to be recommended as an article of diet in cases of exhaustion. Kali Bromatum. The first potash preparation we will consider is Kali bromatum or Bromide of Potassium. We find that this drug is antidoted by Hepar mainly. It has some few analogous or concordant remedies, Ambra grisea, Hyoscyamus, Stramonium, Tarentula and Mygale. Bromide of Potassium acts mainly upon the nervous system and acts, too, in two opposite directions. Primarily, it decreases reflex action; secondarily, it depresses the mind. This property of the drug to modify reflex action has led to its extravagant use in the treatment of epilepsy. It is given in progressively increasing doses until the system is affected by what is known as bromism. When the system has be- come saturated with the drug, then it is discontinued for awhile. The first effect of the drug seems to be to increase reflex action, particularly reflex motor action, and it is on this quality of the Bromide of Potassium that the allopath bases his prescription. Every little disturbance in the periphery of the nerves, every little alteration in the function of an organ, is at once reflected to the nervous centres, and produces some other disturbance, either an uncomfortable sensation, twitching of muscles, anxiety, headache or even absolute convulsions. This is the first condition of the Bromide of Potassium. You know that this is the starting point of almost all convulsions. Witness for instance, a case of eclampsia, where the pressure of the child on some of the nerves in the pelvis or against an undilating os, causes spasms; or still another case, where some indigestible substance iu the stomach produces con- KALI BROMATUM. 675 vulsions. This reminds you at once of Stramonium, in which a bright light, by affecting the retina, reflects the irritation to the brain and causes convulsions. As a result of this oversensitiveness to external impressions, we have quite a number of characteristics of the Bromide of Potassium. Many of these are symptoms of the drug calling for its exhibition in acute mania, when there are sleeplessness and strange imaginations. The patient imagines that he will be poisoned; that he is pursued by some demon; that he is hated by everybody, or that his honor is at stake. Some such impression acts on the mind irresistibly, and causes him to resort to violent procedures; thus, he will try to commit suicide in order to avoid the supposed danger. All this time, the pupils are dilated, and the face bright red and expressive of anguish and fear. The body trembles, and the muscles twitch in various parts of the body. You see how this resembles Hyoscyamus, both being parallel remedies in this form of disease. Kali bromatum has also acted very well in the night-terrors of chil- dren, when from over-excitement of the brain, whether it be reflex from dentition or worms, or even from affection of the brain itself, the child shrieks out in its sleep, and if old enough, will complain of seeing hob- goblins, ghosts or something of that kind. Even when that symptom occurs in impending dropsy of the brain, Bromide of Potassium may be the remedy. We have another condition calling for Kali bromatum, and this seems to be an irritability of the nerves, not only of the brain, but of the whole body. This irritability is expressed by the following symp- tom: The patient is nervous and cannot sleep, and feels better when engaged at some work. He is either busy playing with his fingers or he is walking about, or in some way occupying his mind or body in some exertion; then he feels better. Simple sleeplessness will not be relieved by Kali bromatum unless there is this relief from activity or motion. In this respect, I find it similar to Tarentula, which also has this irritation of the periphery of the nerves relieved by exercise and by rubbing. The patient plays with her dress, or with her watch-chain, as if to work off this over-irritation of the peripheral nerves. Even in the case of the headache of this remedy, the patient rubs the head against the pillow for relief. Another remedy which is similar to Kali bromatum in this over- excitability, is Ambra grisea, which has this same sensitiveness to 676 A CLINICAL MATERIA MEDICA. external impressions, the slightest influence causing excitement and difficulty in breathing. Ambra grisea, however, almost always has some sort of vertigo associated wdth its other symptoms. It is a very quick-acting drug. Conversely to this primary action of Kali bromatum, we have an- other, one of great depression of the cerebro-spinal nervous system. Thus we find it producing absolute loss of memory. The patient can- not remember words particularly. Associated with this symptom we find a distressing melancholy; everything looks dark and gloomy. He cares nothing for anybody nor for his occupation. This condition of things often follows excesses iu venery, in which case Kali bro- matum is an excellent remedy. There is also a sort of ataxia developed. The. patient seems to be unable to manage his legs as he should. There are numbness and tingling in the legs and in the spine; this symptom being accompanied, in the first stages, by an increase in the sexual appetite, but as the case advances-it is associated with absence of erection and, too, frequent nightly emission of semen, thus increasing the melancholy. You will find Bromide of Potassium indicated for business men who have worked long and hard, who have pored over difficult prob- lems until they have this dizziness, this staggering when they walk, and this benumbed feeling in the brain. It was only yesterday that I prescribed it for a business man on Third street, who has been work- ing himself almost to death. I expect that it will relieve him promptly and effectually. He said that when he had been working at his books he would get a numbness in the back of the head, and a certain indescribable terrified feeling, as though he was going to lose his senses. Good results might also be obtained in this case by the galvanic current, the positive electrode being applied to the cervical region and the negative on the vertex. But Kali bromatum will give a more permanent relief. Now, a word about Kali bromatum as an anti-epileptic remedy. I do not believe that it ever cured epilepsy. In almost all cases in which it has been given, it has not cured but simply suppressed the disease, and thus has produced a worse condition than the one previously existing, namely, imbecility. Kali bromatum produces lesions of the skin. Its long-continued use gives rise to little, hard, dark red papules on the face, surrounded by little vesicles and ending in suppuration. We may, therefore, use the drug in acne, particularly that resulting from masturbation. KALI HYDRIODICUM. 677 Another form of eruption which the Kali bromatum produces is a livid blotch as large as one's thumb-nail, covered with scales, and hav- ing in its centre a yellowish appearance as if it were suppurating. After a while it does suppurate and discharge, leaving a central depression, something like that of the small-pox pustule. Still a third form of eruption, is an eczema which evidently arises from the action of Kali bromatum on the sebaceous or sudoriferous glands, causing an abscess in each of these and developing a scaly eruption. Kali Hydriodicum. The Iodide of Potassium, or Kali hydriodicum, does not, like the Bromide of Potassium, act on the higher tissues of the body. It seems to affect more the lowest tissues, as the fibrous, acting particularly on the periosteum and the connective tissue wherever they may be found. It attacks the nervous tissues ultimately, probably by involving the neuroglia. The tendency of the drug is to produce infiltration, so that when it is thoroughly indicated you will almost always find an oedematous or infiltrated state of the part affected. Some of the symp- toms produced by Iodide of Potassium are due directly to the iodine which it contains. For instance, what is known as iodine intoxication may be developed by the drug. The patient exhibits a great deal of anxiety about the heart, the face is flushed, the head is hot, and the patient very talkative; in fact, he acts pretty much the same as would a man under the partial influence of liquor. The headache which Kali hydriodicum causes is one of external head, probably from the action of the drug on the aponeurosis of the occipito- frontalis muscle, because there appear hard lumps like nodes on the scalp and these pain excessively. This may be a remote symptom of syphilis or of mercurialization, or it may appear in a patient with the rheumatic diathesis. In affections of the eyes Kali hydriodicum is called for principally by the violence of the symptoms, especially in syphilitic iritis after the abuse of mercury. Now, if mercury has not been abused, I do not con- sider the Iodide of Potassium to be the best remedy. If there is any best remedy for iritis it is Mercurius corrosivus. We may also use Kali hydriodicum for inflammation involving both choroid and iris, the result of syphilis. More externally we find pustular keratitis, with chemosis, especially after the abuse of mercury. Coming next to the nose, we have the following indications for the Iodide of Potassium: Coryza or catarrh, occurring repeatedly in 678 A CLINICAL MATERIA MEDICA. patients who have been mercurialized; every little cold or exposure, or every damp day causes the nose to become red and swollen; an acrid watery discharge flows from it, and the eyes smart and lachrymate, and become puffed. The patient is alternately chilly and hot, the urine is high colored (as the patient expresses it) and scanty, and there is usually some sore throat. Every exposure provokes a return of these symptoms. Kali hydriodicum also cures this thin excoriating nasal discharge when it appears as an inheritance from syphilitic parents. The ozaena which it cures is either scrofulous, syphilitic or mercurial, or a combi- nation of all these. The discharge may be either thin and acrid, or else thick, green and offensive, and attended with burning sensation in the nose and even perforation of the nasal bones. Next, the action of Iodide of Potassium on the lungs and heart: It is not a little singular that all the preparations of Mercurius produce sharp, stitching pains through the lungs (through either the right or left lung, and shooting in different directions), and that the very best antidote to mercury also produces stitching pains through the lungs, particularly through the sternum to the back; worse from any motion. Now, there are two very different conditions in which Iodide of Potassium is to be here thought of. One of these is in pneumonia, in which disease it is an excellent remedy when hepatiza- tion has commenced, when the disease localizes itself, and infiltration begins. In such cases, in the absence of other symptoms calling dis- tinctively for Bryonia, Phosphorus or Sulphur, I would advise you to select either Iodine or Iodide of Potassium. It is also called for when the hepatization is so extensive that we have cerebral congestion or even an effusion into the brain as the result of this congestion. Now, the symptoms in these cases are as follows: First, they begin with very red face, the pupils are more or less dilated, and the patient is drowsy; in fact, showing a picture very much like that of Bella- donna. You will, in all probability, give that remedy, but it does no good. The patient grows worse, the breathing becomes more heavy, and the pupils inactive to light, and you know then that you have a serious serous effusion into the brain, which must be checked in a short time or the patient dies. Why did not Belladonna cure? He who would prescribe by the symptoms alone in this case would fail, because he has not taken the totality of the case. The trouble did not start in the brain. The cerebral symptoms are secondary to others. What, then, is the primary trouble? You put your ear to the patient's chest KALI HYDRIODICUM. 679 and you find one or both lungs consolidated; hence the blood cannot circulate through the lungs as it should, and the different organs in the body become congested. So, until you have proved Belladonna has produced such a condition, you cannot expect it to do any good. Another condition in which we may use Iodide of Potassium is in pulmonary oedema, thus again showing you the infiltration producible by the drug. This is almost always, as you know, a secondary trouble. The expectoration looks just like soapsuds, only it is apt to be a little greenish. We may also have Kali hydriodicum indicated in phthisis pulmo- nalis, particularly if there is present this same sort of frothy expecto- ration, night-sweats, and loose stools in the morning. The cough is of a violent racking, tearing character, and is worse in the morning, thus keeping up the character of the potash salts, to have aggravation of the chest symptoms from two to five o'clock in the morning. I may say that these symptoms of the lungs are often consecutive to Bright's disease, in which disease Kali hydriodicum may be the remedy. Yerba santa is used by eclectics for phthisis of catarrhal origin. It is used empirically. There is a gentleman who has a tendency to catarrhal asthma, with thickening of the bronchial tubes and constant oppression of breathing. I treated him for a year. Sulphur seemed to be indicated, but was given with only partial relief. Finally, I gave him Yerba santa in the tincture. It so far relieved him that every morning he coughed up a quantity of sputum, and there then followed a freedom of breathing he had not had for years. The action of Kali hydriodicum on the heart is also characteristic. It produces a horrible smothering feeling about the heart, awakening the patient from sleep and compelling him to get out of bed. This symp- tom is also found under Lachesis, Kali bichromicum, Lactuca, Euphrasia, Graphites, and some others. It is also useful for repeated attacks of endocarditis or pericarditis of rheumatic origin. There are sharp, darting pains in the heart, worse from any motion, and particularly bad from walking. In disease of the spine you will find Kali hydriodicum indicated by these symptoms: Feeling as if the small of the back were being squeezed in a vise; bruised pain in the lumbar region and difficulty in walking; spinal meningitis with oedema or exudation, particularly when of syphilitic origin. When gummatous tumors involve the nervous tissues Iodide of Potassium is your only hope. 68o A CLINICAL MATERIA MEDICA. It may also be of use when rheumatism involves the spine and para- plegia results. In these cases I think that it is the neuroglia that is attacked. It may still further be used in rheumatism of the joints, particularly of the knee. The knee-joint is swollen and has a doughy feel; here, again, you see the tendency of the remedy to produce infiltration of tissue. There is no fluctuation to be detected. The skin about the inflamed joint is apt to be spotted, and the pains are of a gnawing, boring character, and are worse at night. In sciatica you may give Kali hydriodicum when the pains are worse at night, and from lying on the affected side, and when the trouble is of mercurial or syphilitic origin. You will find that the Iodide of Potassium will help you in the treatment of the so-called contracted kidney, especially when of mercu- rial origin. Iodide of Potassium, like all the potash preparations, produces an eruption of a papular or of a pustular character. Especially do these appear on the scalp and down the back; when they heal they leave a cicatrix. You may also remember Iodide of Potassium as a remedy for tertiary syphilis, particularly rupia. The best antidote to Iodide of Potassium is Hepar. LECTURE LXX. KALI BICHROMICUM. To-day I shall lecture on Kali bichromicum, or the Bichromate of Potash. You would expect in a drug having the combination of this one, to obtain not only the results of potash, which forms the base of the salt, but also the modifying influence of the chromic acid. You will find, therefore, that while there are evident general resemblances to the other Kalis, there are decided differences arising from the acid combined with it. Chromic acid, as you probably well know, is a highly irritating acid. It is a powerful escharotic, destroying animal tissue very rapidly, and penetrating quickly into the part, and so pro- ducing a deep ulcer or sore. Kali bichromicum is a drug which acts generally, although not ex- clusively, on fat persons, especially on fat, chubby children more than on adults. We find that it possesses great virtues in inflammation of mucous surfaces, with tendency to plastic exudation and pseudo-mem- brane. It attacks mucous membranes, causing at first inflammation of these, violent in character and associated with a great deal of redness and swelling, and at first a production of an excessive amount of mucus, from over-action of the muciparous glands. This excessive mucous secretion is very rapidly turned into a fibrinous exudate; hence there is a tendency to the formation of false membranes. This character of the exudation on mucous surfaces gives us the well-known characteristic of the Bichromate of Potash, discharges are ropy and stringy. This symptom is true of the coryza, it is true of the discharges in pharyngitis and laryngitis, and it is true of the vomited matters in gastric catarrh. It also applies to the leucorrhcea and also to the gleety discharge from the urethra, which may sometimes call for Kali bichromicum. Illustrations, then, of this general characteristic of the drug are not wanting in any part of the body. We find even in scrofulous children, for whose diseases Kali bichromicum is often an excellent drug, this same quality to the mucous discharges. For in- stance, it is indicated in inflammation of the middle ear, particularly when it affects the membrana tympani. There is ulceration not only of the membrana tympani, but also of the mucous surface of the middle 682 A CLINICAL MATERIA MEDICA. ear. The distinction between Kali bichromicum and other remedies in these cases is that the discharge is tenacious, stringy and purulent. With this there will be earache, with pains of a sharp stitching character which shoot up into the head and down into the neck. You will find the glands of the neck swollen and also the parotid gland on the affected side. This becomes large and indurated, and pains shoot from the ear down and into the swollen parotid. In diseases of the mucous membrane of the throat we find this same character to the exudation. Thus, in diphtheria, we find Bichromate of Potash indicated under two or three contingencies. It may be a remedy when diphtheria assumes the croupous form. The membrane is quite thick, and is decidedly yellow-looking, like wash-leather. The dis- charges, whether coming from the nose or throat, or both, are decidedly stringy. This has been, in my mind, a sufficient distinction between Kali bichromicum and the Iodides of Mercury. When I am giving Iodide of Mercury in diphtheria, as soon as I find that the expectora- tion becomes stringy I change to Kali bichromicum if it suits that condition, and also because it may prevent the extension of the disease to the larynx. Although, in general, Kali bichromicum is suited to rather sthenic types of inflammation, yet we have indications enough to prove that it may be suited to the adynamic cases also. The Iodide of Mercury is to be thought of in diphtheria when the membranous deposit is more or less profuse, involving the tonsils and posterior nares. The glands in the neck are swollen. The tongue is coated dirty yellow. There is excessive production of mucus in the throat, causing a great deal of " hawking." We find Kali bichromicum indicated in still other forms of inflam- mation of the throat than diphtheritic. Thus, it is called for in fol- licular pharyngitis. The follicles of the throat become hypertrophied and look like little tubercles on the pharyngeal walls. These discharge a white cheesy-like mass, which, when crushed between the fingers, gives forth a foetid, disagreeable odor. These are attended by a feeling of roughness and dryness in the throat, and at times by an accumula- tion of tenacious mucus. You will find this disease a stubborn one to treat. In addition to Kali bichromicum, it will be well enough to remember Hepar, Kali chloricum (especially when there is a great deal of foetor of the breath) and Aisculus hippocastanum, or the horse- chestnut. AEsculus resembles Kali bichromicum very closely, but lacks the tenacious stringy mucus. There is dry, rough, burning feeling in the throat and pharynx and yet no swelling. The face is sallow and • KALI BICHROMICUM. 683 digestion is slow. There is tendency to portal congestion, as shown by deep throbbing in the hypochondrium, and constipation and haemor- rhoids. In other cases you will have Nux vomica indicated by well-known symptoms, which I need not here repeat. Still other cases call for Secale cornutum, which has hawking up of these little follicular exudates. We have Kali bichromicum indicated in yet another form of throat disease which is neither scrofulous nor croupous nor diphtheritic, but syphilitic. Ulcers form on the fauces and tend to perforate. The sur- rounding mucous surface is of a coppery-red color. It is also indicated in nasal catarrh. It produces, at first, dryness of the nasal mucous membrane, with tickling in the nose and sneezing, these being especially marked in the open air. The secretion from the nose is ropy and stringy, and often collects in the posterior nares. It may or may not be offensive. At other times, as in ozaena, there are discharges from the nostrils or posterior nares consisting of plugs, or clinkers, as they are sometimes called. Lumps of hard green mucus are hawked from the posterior nares, particularly in the morning. At other times (often in syphilitic cases) you will find ulcers which carry out the perforating character of Chromic acid, and tend to perforate the parts on which they are located. Kali bichromicum is indicated in true membranous croup. It suits best, although not exclusively, light-haired, fair-complexioned children who are rather fat and chubby. The cough has a decidedly metallic sound. It has more than the mere bark of catarrhal croup. The fauces you will generally find quite red; the tonsils, perhaps, are some- what red and a little swollen. The cough seems to descend; that is, the rattling goes down lower and lower until it apparently reaches the upper part of the epigastrium, or rather the lower third of the sternum, the irritation of the cough seeming to start from there. In this posi- tion, as well as in the throat, there seems to be a smothering, oppressive sensation; breathing becomes very labored. The child has smother- ing spells, arousing it from sleep, choking. The whole chest heaves with the efforts at respiration. The membrane forms quite thickly in the larynx, narrowing its lumen. The expectoration is tough and stringy, and, perhaps, mucous, and contains pieces looking like boiled maccaroni. The patient is worse in the morning from three to five o'clock. Sometimes there is a tendency in these cases of croup to ex- 684 A CLINICAL MATERIA MEDICA. tend downwards and involve the trachea, and even the bronchi, giving rise to what has been termed croupous bronchitis. This is not a very common disease, but it is an exceedingly dangerous one. I remember treating a patient who, after taking Kali bichromicum, expectorated pieces looking like vermicelli and having numerous little branches, probably casts of the ramifications of the bronchial tubes. One of the remedies following Kali bichromicum well in throat and croupous diseases is Lachesis. It suits particularly when the spasmodic cough becomes so violent as to cause choking spells, and when the patient drops off to sleep, he awakens as if smothering. Kali bichromi- cum has modified the inflammation, but has not succeeded in preventing spasm of the throat. Then Lachesis comes in and relieves the remain- ing symptoms. Then, should the croupous symptoms increase, you may return to Kali bichromicum. There is also a resemblance between Mercurius cyanatus and Kali bichromicum in diphtheritic croup. Kaolin is very useful for membranous croup when it extends down- wards, and when one of the characteristic symptoms is intense soreness along the trachea and upper part of the chest. The mucous membrane of the stomach, too, fails under the influ- ence of Kali bichromicum. The drug is so irritating that it causes gastritis. Thus it produces gastric symptoms varying in severity all the way from those of simple indigestion to those of malignant disease of the stomach. In the milder forms of dyspepsia we find it indi- cated when there is headache, the pain usually being supra-orbital. This may be periodical in its return, but is particularly excited by gastric irritation. Although it is neuralgic in its character, it is reflex from gastric irritation. Another form of headache which is associated with these gastric symptoms is one of a peculiar kind. The patient is affected with blindness more or less marked, objects become ob- scured and less distinct, the headache then begins. It is violent, and is attended by aversion to light and to noise, and the sight returns as the headache grows worse. I have met with that symptom in my practice four or five times. I have found the same symptoms pre- cisely given under Gelsemium, but I have never used that drug under these circumstances, so I have not confirmed it. There are quite a number of remedies having blinding headache, but Kali bichromicum is the best of them. We have Causticum sometimes indicated for blindness with the headache, but not diminishing as the headache increases. We also find it under Natrum mur., Iris versicolor, Psor- KALI BICHROMICUM. 685 inum and Silicea. In the latter remedy the blindness comes after the headache. With this headache of Kali bichromicum the face is apt to be blotched and bloated, and covered with pimples or acne. It is also sallow and yellowish, as if the patient were bilious. The whites of the eyes are yellow and a little puffed. The tongue is thick and broad and scalloped on its edges, as though it had taken the imprint of the teeth. The stomach seems to swell up immediately after a full meal, just like Lycopodium. The bowels are constipated, or else there is early morning diarrhoea, as you find under Sulphur, Rumex, Bryonia and Natrum sulph. The stools are watery, and are followed by tenesmus. These are some of the gastric symptoms which will yield to Kali bichromicum. They are particularly apt to occur after excessive beer drinking. Kali bichromicum is one of the best remedies for the chronic effects of excessive indulgence in beer and ale. We also find Kali bichromicum producing gastritis, herein very much resembling Arsenicum. The vomited matter is sour, and is mixed with clear mucus. You see how Kali bichromicum everywhere excites an over-production of mucus. The vomit may be bitter from admixture of bile. It is renewed by every attempt at eating or drink- ing, and is associated with a great deal of distress and burning raw- ness about the stomach. With this kind of vomit you may give Kali bichromicum in the vomiting of drunkards and in the round, perforating ulcer of the stomach. In dysentery, Kali bichromicum is sometimes indicated. The disease occurs periodically in the spring or in the early part of the summer. The stools are brownish and watery, and mixed with blood and attended with great tenesmus. The distinctive symptom is the appearance of the tongue, which is dry, smooth, red and cracked. In its action on the skin, Kali bichromicum causes first of all, a rash which very much resembles that of measles. Kali bichromicum has been given in measles with these symptoms: It is particularly indicated after Pulsatilla. The latter remedy is suited for the milder symptoms, the former for the more severe. The inflammation of the eyes grows worse with the formation of vesicles or pustules on or about the cornea. The meibomian glands or other structures of the lids ulcerate, so that the lids agglutinate, and there is more or less purulent discharge from the eyes. The ears, too, become involved, and there is a discharge from the ears of quite offensive pus. There are also violent, stitching pains which extend from the ear to the roof 686 A CLINICAL MATERIA MEDICA. of the mouth and to the parotid gland on the affected side. The ex- ternal auditory meatus is greatly swollen. Kali bichromicum is one of the best remedies we have, when measles is associated with these ear symptoms and swelling of the glands, with sharp pains shooting from the ears into the glands. There is also diarrhoea which resembles that of Pulsatilla, but differs from the latter in the presence of slight tenesmus. The rash is the same as we find in nearly every case of measles. In a general way, we may say that it resembles Pulsatilla, only it is Pulsatilla much worse. It has the simple catarrh of Pulsatilla, watery or more commonly yellowish green secretions, made worse and even advancing to ulceration. We next find Kali bichromicum, like all the potash salts, producing papules. These papules are hard and tend to enlarge and develop into pustules. In extreme cases, these pustules may even develop into' ulcers. We have also developed by Kali bichromicum symptoms resembling those of sycosis. This places the drug alongside of Thuja, Pulsatilla and Sarsaparilla. We find scabs on the fingers, often about the nails, and also on the corona of the glans penis. There is a gleety discharge from the urethra, which is very often stringy, thus keeping up the general action of Kali bichromicum on mucous membranes. Ulcers looking like chancres, and tending to eat deeply rather than spread superficially, form about the glans penis and prepuce. In addition to these symptoms you must have the inflammation of the nose and throat of the character already described, with perforating ulcers affecting even the bones. Kali bichromicum is also called for in inflammations of the eyes; this inflammation being rather indolent in character. There is lack of reactive power, so that ulcers form which progress slowly and show but little tendency to heal of their own accord. The same is true of the conjunctivitis, which may be of scrofulous or of sycotic origin. The lids are swollen and agglutinated, especially in the morning, with thick yellow matter, and, to keep up the indolent character of the remedy, you find very little photophobia. Sometimes we find chemosis with these cases. You will find that iritis, whether syphilitic or not, may call for Kali bichromicum. It is indicated, not in the beginning but late, when there has been exudation posteriorly between the iris and crystal- line lens, causing adhesions of these structures to each other. These exudations, if not too great, will be absorbed under the action of Kali KALI BICHROMICUM. 687 bichromicum. Characteristic of this iritis is indolence. There is little or no photophobia and not a very decided redness attending the in- flammation. This is a general hint which will guide you to Kali bichromicum, and will save you the memorizing of less characteristic symptoms. Do not, therefore, forget the indolence of the ulceration, the absence or deficiency of inflammatory redness and the dispropor- tionate absence of photophobia. We next come to the action of Kali bichromicum on the chest. It is indicated in bronchitis, particularly if the glands are involved. Pos- teriorly, on either side of the spinal column, you find dullness on per- cussion. The cough is of a hard, barking character, almost as in croup. It seems to start from the epigastrium. The expectoration is generally of a stringy character. Sometimes it consists of bluish lumps, and is attended with a great deal of difficulty of breathing, arising mechani- cally from thickening of the lining membrane of the bronchial tubes. This cough is almost always made worse after eating, and is better when warmly wrapped up in bed. There is a great deal of feeling of tightness in the epigastrium. You must also remember Kali bichromicum as a remedy indicated in asthma dependent upon bronchiectasia. The bronchial tubes are filled up with this tough tenacious exudation. But we find Kali bi- chromicum indicated in another form of asthma, which is worse from three to four o'clock in the morning, and is especially liable to return in the winter weather or in summer time, when chilly. The patient is compelled to sit up in bed in order to breathe. Relief comes when the patient raises stringy mucus. This kind of asthma calls for Kali bi- chromicum, whether the patient be stout or thin. If you have this after midnight aggravation and relief from sitting up and bending forward, and from the expectoration of stringy mucus, you have a certain remedy in Kali bichromicum. Here is it a perfect complement to Arsenicum, which has nearly the same symptoms, but lacks the tenacious sputum. The low potencies have been most successful in the treatment of asthma. The high potencies have not failed, but in all of the literature that I have been able to see, the low potencies have seemed to be the most successful. Whether this is true or not, I do not know. I only give you the facts as I find them, that you may judge for yourselves. Lastly, I have to speak of the use of Kali bichromicum in rheu- matism, particularly in rheumatism which occurs in spring or summer weather, when there are cool days or nights. The smaller joints seem 688 A CLINICAL MATERIA MEDICA. to suffer. Thus we have pains about the fingers and wrists more than in any other part of the body. Pains wander from one part of the body to another. Gastric and rheumatic symptoms alternate. I have had several instances in which I have been able to confirm this char- acteristic of the drug. LECTURE LXXI. CAUSTICUM. Causticum is evidently a potash preparation, but its exact compo- sition I do not know. Hahnemann was not able to define it, and chemists since his time have not been able to tell of what it is com- posed. Nevertheless it is an unique remedy, and is one that we cannot do without in practice. The drug is coveniently studied under the heads placed on the board. Causticum. Carbo veg. Lachesis. Coloc Rhus, Dulc, Aconite, Colch. Guaiacum. Paralysis. Spasms. Rheumatism. Mucous membranes. Skin. Organs. 2 fluoric acid, 491 hamamelis, 324. 491 lycopodium, 410 Pulsatilla, 323 VARIOLA anacardium, 203 antimonium tart., 551. "53 apis, 102 rhus tox.. 218 VERTEBRAL CARIES carbo veg., 453 Gettysburg water. 320, 515. 623 phosphoric acid, 500 phosphorus, 543 silicea, 514 sulphur, 543 VERTIGO ambra grisea, 144 argentum nitr., 574 arsenicum, 37 bromine, 472 camphor, 37 causticum, 690 conium, 417 digitalis, 37 ferrum, 609 hydrocyanic acid, 37 lachesis,- 36 laurocerasus, 37 moschus, 37 oleander, 157 rhus tox., 219 sanguinaria, 257 silicea, 518 theridion, 37, 78 veratrum alb., 37 VOMITING aethusa cynap., 419, 548, 637 antimonium crud., 419, 548, 637 antimonium tart., 247. 361 apomorphia, 247, 406 arsenicum, 637 77© THERAPEUTIC INDEX. VOMITING (Continued) belladonna, 248, 406 bismuth, 535 cadmium sulph., 53, 524 calcarea acetica, 419 calcarea ostr., 419, 637 colchicum, 57 digitalis, 361 glonoin, 248, 406 ipecacuanha, 247, 549 kreosote, 535, 637 lachesis, 53 lobelia, 247 nux vomica, 175 phosphorus, 637 rhus tox., 248, 406 tabacum, 361 veratrum alb., 57 VOMITING OF PREGNANCY anacardium, 205 digitalis, 362 nux vomica, 183, 205 petroleum, 469 WARTS causticum, 694 WAXY LIVER phosphorus, 537 WHITE-SWELLING phosphorus, 543 sulphur, 440 WINE, AGGRAVATION FROM antimonium crud., 601 fluoric acid, 601 glonoin, 601 ledum, 601 nux vomica, 601 Pulsatilla, 601 WINE, AGGRAVATION FROM (Con- tinued) rhododendron, 601 selenium, 601 zincum, 600 WHOOPING-COUGH ambra grisea, 144 antimonium tart., 551 arnica, 226 cina, 230, 315, 357 coccus cacti, 31, 595 corallium rubrum, 27, 31 cuprum, 357 drosera, 27 ipecacuanha, 357 kali bichromicum, 32 kali carb., 700 mephitis, 27 senega, 32 WORMS aconite, 229 artemisia, 593 caladium seguinum, 230 cicuta, 419 cina, 229, 593 ignatia, 191, 229 indigo, 191, 230 quassia, 230 sabadilla, 240 spigelia, 424 stannum, 593 YELLOW ATROPHY OF THE LIVER phosphorus, 537 YELLOW FEVER cadmium sulph., 524 carbo veg., 453 lachesis, 53 T 7s- cra o M ■ ivi'i> umm\ ! hi'tl III ill ■iilil \<\ I'-Hiiij'lt!; l!!,li; WWM WttW I lli